This book is dedicated to the memory of my father, Donald M. Barnard, MD, a

kind and wise physician, and to the participants in our research studies. I am

deeply grateful for your important contribution to this work.

“Dr. Barnard’s solid scientific work…represents a major turning point in the

treatment and outcome of diabetes. Revolutionary in its implications and

spectacular in its clarity, this book—with its simple, safe dietary approach—will

bring hope to millions.”

—Hans Diehl, DrHSc, MPH, FACN, chairman of the Lifestyle Medicine

Institute in Loma Linda, California, and director of the International

Nutrition research Foundation

“Dr. Barnard’s superb book shows us the numerous advantages of following his

nutritional program.”

—William C. Roberts, MD, editor in chief of the American Journal of

Cardiology and executive director of the baylor Heart and Vascular Institute

in Dallas

“A promising alternative dietary approach in the treatment of diabetes.”

—William E. Connor, MD, professor of medicine and clinical nutrition at

Oregon Health and Science University in Portland

CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION:  A  NEW  APPROACH  TO  DIABETES
PART  1.  THE  BREAKTHROUGH
CHAPTER  1.  The  New  Basics
CHAPTER  2.  Reversing  Type  2  Diabetes
CHAPTER  3.  A  Revolution  in  Type  1  Diabetes
PART  2.  THE  PROGRAM
CHAPTER  4.  A  Powerful  New  Menu
CHAPTER  5.  How  to  Get  Started
CHAPTER  6.  Healthful  Weight  Control
CHAPTER  7.  How  to  Test  Yourself  and  Track  Your  Progress
CHAPTER  8.  A  Perfect  Diet  in  an  Imperfect  World
CHAPTER  9.  Troubleshooting
CHAPTER  10.  Which  Supplements  Should  You  Take?
CHAPTER  11.  Exercise  for  the  Rest  of  Us
PART  3.  COMPLETE  HEALTH
CHAPTER  12.  A  Healthy  Heart
CHAPTER  13.  Healthy  Nerves,  Eyes,  and  Kidneys
CHAPTER  14.  Information  for  Clinicians
MENUS  AND  RECIPES
NOTES

ACKNOWLEDGMENTS

I would like to thank the many doctors, nurses, dietitians, and people with

diabetes who used the first edition of this book and shared their experiences

along the way. They have underscored the power of this approach and the great

need for it at a time when the causes of diabetes and the nutritional approach to it

remain only dimly understood by a surprisingly large number of caregivers and

patients.

The research that culminated in this book was a team effort. I especially want

to express my deepest appreciation to the research volunteers who put up with

many early mornings, late nights, and needlesticks in performing an important

public service. You have taught me a great deal and helped our research

immeasurably.

I greatly appreciate the support of the National Institute of Diabetes and

Digestive and Kidney Diseases of the National Institutes of Health, particularly

Sanford Garfield, PhD, and of the Diabetes Action education and Research

Foundation and its director, Pat DeVoe, RN, BSN, without which our initial

research on diabetes would not have been possible. Thank you also to GEICO

for allowing us to test this approach in the work setting in cities across the US

and to the American Diabetes Association for the opportunity to share our

findings along the way.

Joshua Cohen, MD, of the division of endocrinology at George Washington

University, was instrumental in planning and guiding our research work. David

J. A. Jenkins, MD, PhD, DSc, of the University of Toronto, is an extraordinary

mentor whose generosity with his time, knowledge, and ideas is something I

hope to pass on to other investigators.

Caroline Trapp, DNP, ANP-BC, CDE, FAANP, has applied this approach in

extraordinary ways in her clinical work and in her innovative programs with

Native Americans and, along with Meghan Jardine, MS, MBA, RDN, LD, CDE,

has educated and empowered thousands of caregivers.

Susan Levin, MS, RD, Francesca Valente, Rosendo Flores, Jill Eckart,

Suruchi Mishra, PhD, Joseph Gonzales, RD, Gabrielle Turner-McGrievy, PhD,

RD, and Lisa Gloede, RD, CDE, helped extensively in research planning and in

guiding our research participants toward more healthful ways of eating. Brent

Jaster, MD; Amber A. Green, RD; Kim Seidl, MS, RD; Trulie Ankerberg-Nobis,

RD; Dulcie Ward, RD; Jennifer Reilly, RD; and Mary Ellen Wolfe, RN, CDE,

and Robyn Webb shared their expertise and guidance with me and our research

participants. Thanks to Paul Poppen, PhD, for his expert assistance in planning

and executing the statistical analyses. Andrew Nicholson, MD, and Mark Sklar,

MD, guided our initial research on diabetes, and Larry Kushi, PhD, provided

thoughtful advice along the way. John A. McDougall, MD, and Mary

McDougall provided educational materials and wonderful recipes. Jennie Brand-

Miller, PhD, of the University of Sydney, kindly answered many questions about

her studies of the glycemic index and its use in clinical practice.

Stanley Talpers, MD, kept a watchful eye on medical issues for our

participants, and Brad Moore, MD, served as our safety officer.

Special thanks to Ernest P. Noble, MD, PhD, and Terry Ritchie, PhD, of the

University of California, Los Angeles, for their generosity and expertise in

genetic analyses. Thank you to Donald S. Karcher, MD; Terry Costa; Luce

Merino; Estela Day; Patrice Moore; and everyone at George Washington

University clinical laboratory client services.

Cael Croft provided the wonderful medical illustrations in this book.

Finally, thank you to my literary agent, Brian DeFiore, and my editor, Marisa

Vigilante, for helping to shape this book into its current form; and Bryanna Clark

Grogan for providing wonderful recipes.

INTRODUCTION

A New Approach to Diabetes

This book presents a revolutionary method for preventing, controlling, and

reversing diabetes based on important research findings that have dramatically

changed our understanding of this condition. When this book first appeared, the

idea that diabetes could improve dramatically and sometimes even go away for

all intents and purposes was a novel concept. The prevailing notion was “once

you have diabetes, you’ll always have diabetes,” and the condition just seemed

to lead to more and more complications. We have changed that scenario.

In studies by my research team, funded by the US government’s National

Institutes of Health and the Diabetes Action Research and education Foundation,

along with the work of other researchers, we have completely redesigned the

dietary approach to diabetes. If your experience with diabetes has been one of

gradually escalating medication doses, ever-increasing weight, and increasing

worry about the risk of complications, you will learn how to reverse those

trends.

We will focus on changes in your menu, not on drugs. Yes, medications often

have their role. But I would much rather help you scale back on drugs—or

eliminate them entirely. Doing that means rethinking the foods that you eat. Let

me emphasize that you will not need to cut calories, limit carbohydrates, or stick

to small portions. In fact, you can eat until you are full. If you get hungry

between meals, you are free to eat more. What we will zero in on is the type of

food you eat. That has emerged as the critical factor, as you will soon see.

A NEW IDEA

My father, Donald M. Barnard, MD, spent his entire life treating diabetes. He

grew up on a family farm in the Midwest but soon realized that the cattle

business was not for him. He decided to go to medical school, and after training

at Boston’s famed Joslin Clinic, he began work at a busy community hospital.

He became known as the diabetes expert for the surrounding area. But he and the

other doctors—and their patients—often found diabetes puzzling and frustrating.

He recounted a telling comment made by the clinic’s founder, Elliott P. Joslin,

MD, about diabetes research: “Gentlemen, we don’t need a big research grant.

What we need is a new idea.”

Dr. Joslin made that observation back in the 1950s, and the need has only

grown more urgent as the incidence of the disease has exploded. Worldwide,

more than 400 million people are living with diabetes. Until now, most have

found the condition to be at best an exercise in drudgery. With daily blood tests

and a growing list of medications that aim only to slow the disease’s inevitable

damage, a patient’s life becomes a waiting game, with one complication arising

after another—from nerve symptoms to visual changes and heart and kidney

problems.

Now, at last, we have a much more powerful approach. I’m talking not just

about a bold new idea, but about an entirely new approach to diabetes that has

been tested and proven.

In a series of research studies conducted first with Georgetown University

and George Washington University in Washington, DC, our research team has

proven that many people with diabetes can think beyond delaying inevitable

decline and improve their health dramatically. They can cut their blood sugar,

increase insulin sensitivity, and reduce or eliminate medications, and they can do

this with a simple set of diet changes. Unlike with medication treatments, the

“side effects” of the menu change are good ones: weight loss, lower cholesterol

levels, lower blood pressure, and increased energy.

From the beginning, our studies aimed higher and took a more aggressive

approach to diabetes than clinicians had in the past. The first study was small—

just 13 patients—and it tested a program that relied entirely on changes in diet.

There was no new drug, no magical supplement—not even an exercise program.

But the results were amazing. Two-thirds of patients improved so much that they

were able to reduce or eliminate their medications within 12 weeks. The study

was published in Preventive Medicine in 1999.

1

Then, in a second study, this one involving 59 patients with varying degrees

of blood sugar control—some healthy, others prediabetic or diabetic—we

studied why diet change works. It became clear that the diet shift actually caused

a fundamental change in the body itself. In 14 weeks, the diet led to a 24 percent

improvement in insulin sensitivity—that is, the body’s ability to respond to

insulin, the sugar-storing hormone that is dysfunctional in diabetes. Participants

whose blood sugar levels were in the abnormal range saw them promptly return

to where they belonged. While exercise could increase the benefits even further,

diet changes alone were powerful enough to boost insulin sensitivity and bring

blood sugar under better control. The results were presented at the American

Diabetes Association Scientific Meeting in 2004 and were published in the

American Journal of Medicine in 2005.

2

These studies suggested that this new approach may be the most powerful

nutritional plan ever devised for diabetes. We can do more than try to

compensate for malfunctioning insulin, as doctors have done for decades with

various medications. Rather, we can help the body’s own insulin work properly

again by directly addressing—and improving—the cells’ sensitivity to it, which

is the key issue in type 2 diabetes. Even when the disease has evolved to the

point of serious complications, it is not too late for marked improvements to

occur.

Starting in 2003, with the support of the National Institutes of Health, we

conducted a new research trial to compare our diet, head-to-head, against the

guidelines promulgated by the American Diabetes Association at that time.

These conventional guidelines seemed sensible and were well accepted. Millions

of people followed them, carefully cutting calories and limiting carbohydrates.

But all too often, a familiar story ensued: Despite everyone’s best efforts, the

disease typically worsened over time. Our goal was to see if we could improve

things. The study was conducted with George Washington University and the

University of Toronto and included 99 individuals with type 2 diabetes. The

participants were randomly assigned to either a standard diabetic diet based on

the 2003 ADA guidelines or to the more aggressive diet you will learn about

shortly. Along the way, I presented the study’s initial results at scientific

meetings of the ADA, the American Association of Diabetes Educators, and the

American Public Health Association.

In a careful analysis that kept exercise and medication use constant, we

found that the new diet controlled blood sugar three times more effectively than

the previous “best” diet. It also accelerates weight loss and controlled cholesterol

better than the old gold standard. Other investigators have showed that this kind

of diet also has dramatic benefits for the heart and leads to a big improvement in

blood pressure. It allows many individuals to take charge of their lives again and

to return to health and vigor.

We then ran two studies with GEICO, the insurance company, to see how it

would apply in the work setting in 10 different cities. In a word, it works great

and is easy to implement. We have also documented its efficacy against more

advanced diabetes, focusing on improvements in nerve symptoms.

This book translates these scientific breakthroughs into tools that you can

use, including an easy-to-fol low plan with simple diet guidelines.

A NEW UNDERSTANDING OF TYPE 1 DIABETES

Type 1 diabetes is much less common than type 2. It is usually diagnosed in

childhood and is invariably treated with insulin—hence its former names,

childhood-onset diabetes and insulin-dependent-diabetes.

Unlike people with type 2 diabetes, those with type 1 always need to take

insulin. But they can use diet and lifestyle changes to keep doses to a minimum

and reduce the risk of complications. We also have a new understanding of the

fundamental causes of type 1 diabetes. It may surprise you to learn that the

process that leads to type 1 diabetes begins when the body’s immune system

attacks the insulin-producing cells of the pancreas. As you will see, new research

has revealed what appears to spark this attack and what can help to prevent it.

PERSONAL SUCCESS

Let’s take a look at the experiences of real people who followed the program

described in this book.

Nancy

Nancy learned about our research study from an advertisement in the

Washington Post. She had been diagnosed with type 2 diabetes 8 years earlier. A

cousin of hers had lost some of his eyesight to the disease, and failed kidneys left

him on dialysis. Nancy did not want that to be her future. She was going to fight

back.

Before she joined our study, things had been going in the wrong direction.

Although she had followed a diet designed for diabetes, her blood sugar was

gradually worsening, and the diet did nothing to stop her weight from creeping

upward.

Two years after her diagnosis, her doctor put her on her first diabetes

medication. Eventually, her doctor felt she needed two medications. Still her

blood glucose level continued to rise. As she entered our study, her hemoglobin

A1C level—the key index of blood glucose control, which ought to be below 7.0

percent—was an unhealthy 8.3 percent.

Nancy joined the study because she liked the focus on food rather than on

drugs. With the explosion of diabetes in the population, she intuitively felt that

the problem had to be the kinds of food we eat and that the solution had to be

there, too.

We showed her how to change her diet. There were no limits on how much

she could eat or on how many calories or grams of carbohydrates she could

have. But we did ask her to make a major change in the type of food she chose.

At first, we also asked her not to exercise—that is, not to change her exercise

habits—because we wanted to see what diet changes alone could do. That suited

her just fine—she was very busy at her office, working long hours every day,

and exercise was not exactly her thing. At least not yet.

As she began to follow our recommendations, her weight started to fall,

along with her blood glucose, the latter with surprising speed. After years of

going up and up and up, the trend started to reverse. After 11 weeks, she stood

on the scale: She had lost 14 pounds. And when she rolled up her sleeve and we

checked her A1C, we found that it had dropped from 8.3 percent to 6.9 percent.

All in about 3 months’ time. Her insulin sensitivity was returning.

Nancy’s blood sugar continued to fall. In fact, it fell so much that it became

clear that her medications were now too strong for her. The combination of the

drugs she had been taking, along with the new, powerful diet changes, actually

left her blood sugar too low. It was time to reduce her medications. But as we cut

back on her doses, it turned out not to be enough. After several more months, we

had to stop one of them altogether.

A little more than a year after joining the study, she was 40 pounds lighter.

She stopped her diabetes medications, and yet her A1C is better than it was

before—6.8 percent at her last test.

“The payoff is just incredible,” she said. “But it’s not just the weight loss.

My numbers have gotten dramatically better.”

And there was more—another benefit she had not anticipated. For years, she

had had arthritis pain so severe she could not open a jar. After a few months of a

new diet, she suddenly realized that her arthritis symptoms were completely

gone. (There is actually a fascinating body of scientific literature on diet and

arthritis, which I summarized in an earlier book, Foods That Fight Pain.) The

best part of the story: Nancy’s experience is not unusual for people who make

the diet changes you will read about shortly.

Vance

Vance was just 31 years old when he was diagnosed with diabetes. He had just

changed to a new doctor, and the diagnosis came after a routine blood test. Both

of his mother’s parents had had the disease, but up until that point, Vance had

been in more or less good health. He had been a police officer for 12 years and

now worked in a bank, and he was not in the habit of calling in sick.

Diabetes changed everything. “If I didn’t lose a leg or go blind, I could end

up on dialysis,” he said. And the truth was, he was not in such perfect shape. He

had gradually gained weight over the years, and at just under 6 feet tall, he

weighed 276 pounds. “I didn’t really take my diet or my health very seriously,”

he said. “I grew up on steak sandwiches, pork chops, and chicken. We had

barbecues and cookouts. We had some vegetables, but not a lot of fresh foods. I

didn’t exercise. I just didn’t take any of this very seriously.”

Along with weight problems came difficulties with sexual performance.

Impotence affects many men with diabetes and is common in men who are

overweight. His doctor started him on metformin, a commonly prescribed

medication for reducing blood sugar.

Vance learned about our research study and decided to volunteer—despite a

few misgivings about the prospect of changing his diet. “I never had any diet

restrictions or rules before,” he said. “I never tried to control my diet before. I

always ate whatever I wanted.” But his wife had been a vegetarian for some

time, and she was excited that Vance was ready for a change, too.

The payoff came pretty quickly. His weight started to fall, and over a year’s

time, he lost—to his surprise—about 60 pounds. His A1C, which had been 9.5

percent at the beginning of the study, fell to 7.1 percent after just 2 months.

Fourteen months into the study, it had dropped to 5.3 percent. His doctor was

thrilled and said it was time to stop the metformin.

One more surprise: His problems with sexual performance virtually

disappeared within 3 months. “I haven’t been in this good shape since I was in

the police academy. It is like a weight has been lifted off of me,” he said. “When

I told my mother what I was doing—that I had changed my diet—she was so

happy, she nearly cried, because my dad died at 30. When my grandfather died, I

was the oldest male in my immediate family. We tend to check out pretty quick.

But she saw I was on a different path. I was taking care of myself.”

SUCCESS

As soon as the first edition of this book appeared, we began to hear from many

more people who were putting this method to use and achieving surprising

results. A reader in England sent this message:

I was diagnosed with type 2 last September and was given the

standard diet/lifestyle advice by my doctor and his colleagues here in

the UK. Initially my diabetes was mild and was managed simply with

diet/exercise. With time, however, there was deterioration, requiring

stronger and stronger medication, and I began to experience the early

stages of typical diabetes complications. I was given a copy of Neal’s

book by a caring and concerned friend. I was skeptical at first because

all the (difficult to maintain) diet changes I had made to that point did

not seem to be of any use in tackling the problem. However, I

embraced the plan in the book and really began to enjoy eating the

foods recommended.

Three months after starting out on Neal’s diet, I have had my

second (since diagnosis) review. I was called into the doctor’s office at

very short notice with no explanation given by the administrator on the

phone, just being told that “we need to see you today to discuss your

blood results from last week.” Obviously I was anxious, to say the

least, and was quite worried just what bad news the doc was going to

deliver. The doctor called me in however to ask me what I was doing

because “your blood picture is now more normal than mine, and I

don’t have diabetes.” He then said “I can’t tell you that you no longer

have diabetes because there is no cure for diabetes, but technically, you

don’t.”

My doctor was shocked at my blood numbers; he said that the most

improvement he has ever seen up to that point was typically no more

than 5 to 10 percent in his best-managed diabetes patients. My blood

numbers were apparently more than 60 percent better than my last set

of results in January (before I started Neal’s diet). My doctor is now

recommending Neal’s diet to his other patients with diabetes.

Another reader, Patricia, was working as a defense analyst at the Pentagon.

For most of her life, she had struggled with her weight, and eventually she was

95 pounds heavier than she wanted to be. At age 58, she developed diabetes and

had blocked arteries in her heart. She was making trips to doctors’ offices much

more often than she would have liked and was taking 13 pills and two shots a

day.

But she learned about our approach and put it to work. Patricia ended up

losing 95 pounds. She got off all her diabetes medications. She has more energy

than she has had in years. Her husband followed her lead, and he slimmed down,

too. They are doing things they couldn’t do before, and they feel great.

A woman in Portland wrote that she had started gaining weight after the birth

of her second child. She worked evenings at a catalog call center, and when she

got off work, she found herself at the drive-thru on the way home, ordering

unhealthy things and more food than she needed. Over time, she gained almost

100 pounds.

That extra weight took a real toll, and it gradually robbed her of things she

loved to do. One year, her family went to Disneyland, and she found that she was

really not able to walk around the various sights. She had no energy, and her feet

hurt. After a half-hour, she was pooped, and she had to leave.

One day, the occupational nurse at work called her urgently to let her know

the results of some blood tests she had had. Her fasting blood sugar was 278,

which looked like out-of-control diabetes.

This was a major wake-up call. She was not just heavy; she was in trouble.

Well, she found information from my team about tackling weight problems

and diabetes. Our method focused on food and allowed her to eat as much as she

wanted, zeroing in on the type of food she ate. That sounded really appealing,

and she jumped in.

In the first 3 weeks, she lost 7 pounds, and her blood sugar was starting to

fall, too. After a year, she was down 60 pounds. And today she is at the weight

she wants to be.

And what about her diabetes? Well, her A1C blood test was 10.1 when she

started—that’s way into the diabetic range. But it gradually came down and

down and down, and today it is well below the diabetic range. And her

cholesterol plummeted 63 points.

And her energy is back. Remember the problems she had trying to walk

around Disneyland? Well, today she is on her feet for hours at a time, running

training courses for new employees. And she has energy to burn.

Her skin used to be blotchy and red. And now it’s back to the way it should

be. Headaches, stomachaches, and pains in her feet have all gone away, and she

feels great.

She has taken control, shedding that weight and getting her energy back. And

she loves eating healthful foods that work for her, not against her.

There are many, many more stories of great success from real people. But

now is the time for you to begin your own success story.

TAKING CONTROL

The diet embraced by Nancy, Vance, and the others you have read about here—

and that I hope you are about to begin—is designed to do much more than

simply palliate diabetes, as other diets do. It is designed to tackle the

fundamental causes of the disease.

As those who participated in our study learned, blood sugar levels that creep

steadily upward can also fall. The road to diabetes is in fact a two-way street.

Whether you have type 2 diabetes and want to gain control of your health or

have type 1 diabetes and need to reduce the disease’s intrusion on your life, this

program was designed with you in mind.

However, our research—and this book—also targets a broader purpose.

More and more people, including a surprising number of children, are diagnosed

with diabetes every day. They and their families pay a high personal price with

the condition. And clinics, health maintenance organizations, insurers, and

government programs are struggling to keep up with prescription costs, doctor

visits, and hospitalization charges for its many complications. For many people

at risk, it is simply a matter of time before they are diagnosed. It is our hope that

a new direction in diet and nutrition, if applied broadly enough, can go a long

way toward solving these problems.

This program is truly a revolution in the way we think about this otherwise

unforgiving disease. Diabetes is no longer a condition you simply have to live

with. It need not slowly and inevitably get worse. Quite the opposite. If you have

diabetes, it is time for you to get your life back.

We will not cater to your diabetes. Rather, this program is designed to help

you understand the cause of diabetes and how to correct it to the fullest extent

that diet and lifestyle changes possibly can. If you do not have the disease but

are at risk, this is a powerful program for preventing it.

“Is this program for me?” you may be asking. The answer is an emphatic

yes. Here’s why.

• Whether you like to cook or prefer to eat at restaurants, you can easily

make the diet changes you need. I make this point because some people

imagine that changing their diet means making every meal in their own

kitchens. Translation: hours and hours of work. If you inwardly groan at that

thought, I certainly sympathize: I learned long ago that my temperament is

not suited to spending much time in the kitchen. Perhaps I was born with the

“room service gene,” and maybe you were, too. So I will show you how to

plan a healthful menu and how to make it work for you whether or not you

like to cook. Many of our research participants travel, eat at restaurants, or

eat in their company cafeterias. This program worked for them, and it can

work for you.

• It does not matter whether you love exercise or have never been able to

stick with an exercise plan. The improvements described above were made

without exercise. In fact, our research studies typically omit exercise because

we need to isolate the effect of diet changes in order to put them to a good

test. Having said that, exercise is an important part of any diabetes treatment

regimen, and this book will show you how to bring it into your life in a

sensible, safe, and effective way. If, however, you are unable to engage in

significant exercise because of joint problems, a heart condition, or severe

obesity, or if you find you’re just not able to stick with an exercise program,

you will be glad to know that the benefits of our diet change are not

dependent on any alteration of your activity levels.

• If you have felt that you just cannot stick with a diet, I completely

understand. That’s why we will focus solely on what you eat, not how

much. You can eat until you are full and have snacks when you want them.

You will have to invest some energy, however: You will have to learn to

think about food in new ways. And you will have to unlearn some old,

outdated notions. And if you have been overweight, it is very likely that you

will have to buy some new clothes!

WHAT DOES IT MEAN TO REVERSE DIABETES?

Most people with diabetes find themselves on a road leading toward gradually

increasing weight, slowly rising blood sugar, higher doses of medications, and

worsening complications. Reversing diabetes means reversing this trend. If

weight is an issue, it can come down—gradually, but decisively. Blood glucose

values that have gone up can also come down. Doses of medications that have

risen again and again can come down, too. Symptoms such as neuropathy—

nerve pain in the feet and legs—can improve and even disappear. Heart disease

can be reversed.

Will the disease go away completely? Some people would argue that once

someone has diabetes, that person will always have it, even if blood tests

improve so much that the condition is no longer diagnosable. What they mean is

that the genetic traits that made type 2 diabetes possible do not go away, and

type 1 diabetes requires continued insulin treatments regardless of how well you

adjust your diet.

It is not possible to say in advance how far you can go. Will you be able to

reduce your medication doses, eliminate some or perhaps all of your

medications, or drive your blood sugar down so far that no one would ever know

you once had diabetes? These are questions your own experience will answer,

but I can promise this book will teach you what you need to know about putting

a powerful food prescription to work. The rest of the story is yours to write.

I would be very grateful if you would let others know what you are doing

and perhaps lend this book to your friends or family members who have

diabetes. We know that we can turn this disease around for individuals, but

conquering an international epidemic is a tall order, and it requires a team effort.

I hope you will join in this important cause along with health professionals,

research participants, and their families.

Thank you, and the very best of luck with this program.

PART 1

The Breakthrough

CHAPTER 1

The New Basics

In recent years, much of what we thought we knew about diabetes has been

turned on its head. What is now coming into focus is an understanding of its

fundamental causes, and that gives us power we never had before.

To make sure we are at the same starting point, let me walk you through the

basics: symptoms, diabetes types, and typical treatments as they are currently

used. Then I will show you what’s new.

HOW DO WE KNOW IT’S DIABETES?

First, let’s make sense of the symptoms. Diabetes may arrive with no symptoms

at all, but often it starts with fatigue. For no apparent reason, your spark is just

no longer there. It may also seem that you are losing water more rapidly than

you should be, which is to say that you make trips to the bathroom more often

than usual. And you are thirsty: You find yourself drinking a surprising amount

of water.

Here is what is going on: The fundamental problem is that sugar is not able

to pass from your bloodstream into the cells of your body. From that single

problem come a great many others, like one domino knocking over another and

another and another.

The sugar we are speaking of is glucose—one of the smallest and simplest

sugar molecules. In this case, sugar is not just another word for junk food or

empty calories. The fact is that the cells of your body use this kind of sugar—

glucose—as an energy source. Like gasoline for your car or jet fuel for an

airplane, glucose is your body’s fuel. It powers your movements, your thoughts,

and more or less everything you do.

And that is exactly the problem. If glucose is unable to enter your cells, they

are deprived of their basic fuel, so you lose your energy. That is why you are

fatigued. If your muscles do not have the glucose they need for power, you tire

easily.

Meanwhile, the glucose that cannot get into your muscle cells builds up in

your bloodstream. It becomes more and more concentrated in the blood, and

eventually it starts to pass through the kidneys and ends up in your urine.

*

Now, as glucose passes through your kidneys, it carries water along with it—

lots of water, hence all those trips to the bathroom. What follows, naturally, is

thirst—you are losing all those fluids. So fatigue, frequent urination, and thirst

are all symptoms of one problem: glucose is having trouble getting into your

cells.

You may also find that you are losing weight. And no, this is not an

especially welcome event—not in this situation. You lose weight because your

cells are in essence starving. Nutrients cannot enter your cells, so your body is

malnourished. Yes, even if you are eating plenty of food, nutrients and fuel are

unable to get where they are needed.

Every day, people arrive at doctors’ offices complaining of fatigue, frequent

urination, thirst, and sometimes unexplained weight loss. The doctor takes a

blood sample, finds an unusually high level of glucose in the blood, and

diagnoses diabetes. The doctor then advises the patient that it is essential to get

blood sugar under control. An overly large amount of glucose flooding through

the bloodstream day after day can harm the arteries. Left unchecked, it can

damage the heart and the delicate blood vessels of the eyes, kidneys, and

extremities.

But as we have shown in our research studies, the road to high blood sugar is

a two-way street. When you change your diet and make other healthful

improvements, a rising glucose level can fall. Sometimes the change can be so

dramatic that no doctor looking at you afterward would ever guess that you had

once been diagnosed with diabetes.

How Doctors Diagnose Diabetes

Doctors diagnose diabetes if:

• Your blood glucose level is 126 mg/dl (7.0 mmol/l)* or higher after an 8-hour fast.

• Your blood glucose is 200 mg/dl (11.1 mmol/l) or higher after a 2-hour glucose tolerance

test. This is a test in which you drink a syrup containing 75 grams of glucose, and your

blood glucose value is measured.

• Your A1C blood test is 6.5 percent or higher. A1C is a test that reflects your blood sugar

control over the preceding 3 months or so, unlike a blood glucose test, which will tend to

rise and fall from minute to minute under the influence of foods, physical activity,

medications, stress, and other factors. What the A1C test actually measures is how much

glucose has entered your red blood cells and become stuck to hemoglobin. If you have had

a lot of glucose in your blood, a fair amount of it gets into your cells and sticks to your

hemoglobin.

*US medical laboratories measure glucose in milligrams per deciliter (mg/dl). In most other

countries, glucose is measured in millimoles per liter (mmol/l). As you will see, the same

units are used in cholesterol measurements.

Diabetes Types

A diagnosis of diabetes—or prediabetes—means the insulin in your body is not

doing its job adequately. Insulin is a hormone that moves sugar from your

bloodstream into the cells of your body, among other functions. It acts like a key,

opening a door to the cell, so to speak, and allowing nutrients inside. When

insulin arrives at the cell’s surface and opens the door, glucose is able to enter

the cell, which uses it for power.

If for some reason your body is not making insulin, the result is rising blood

glucose levels. Similarly, your blood glucose rises if your cells resist insulin’s

actions—the key goes in the lock, but the door will not open.

Diabetes comes in three main types, called type 1, type 2, and gestational

diabetes, plus some variants you may need to know about. Let’s look at each

one.

Type 1 diabetes usually manifests in childhood or young adulthood. It used

to be called childhood-onset or insulin-dependent diabetes. In type 1 diabetes,

something has damaged the pancreas’s ability to produce insulin, and you need

to get it from an outside source—typically by injection. However, research has

revealed a great deal about how diet changes can reduce the risk that diabetes

will bring any serious complications your way, as you will see in Chapter 3.

In addition, we know more than ever about the causes of the disease, arming

us with more power to prevent it. The damage to the insulin-producing cells is

caused by the biological equivalent of “friendly fire.” That is, it is caused by the

body’s immune system—our white blood cells that are supposed to fight bacteria

and viruses. These cells ought to protect you, but instead they have attacked the

cells of the pancreas, destroying its ability to produce insulin. In Chapter 3, we

will look at what triggers this process. It may surprise you to learn that foods—

particularly the foods infants are fed within the first months of life—are leading

suspects.

When type 1 diabetes manifests in people who are beyond early adulthood,

the term latent autoimmune diabetes of adults (LADA) is sometimes used. But

the disease is still type 1 diabetes.

Type 2 diabetes used to be called adult-onset diabetes, or sometimes non-

insulin-dependent diabetes. About 9 out of 10 people with diabetes have type 2.

Most people with this form of the disease still produce insulin; the problem is

that their cells resist it. Insulin tries to bring glucose into the cells, but the cells

respond like a door with a malfunctioning lock. In response to these sluggish

cells, your body produces more and more insulin, trying to overcome the

resistance. If the body’s insulin supply cannot overcome the resistance, glucose

simply builds up in your blood.

Diabetes drugs work to counteract this problem: Some make your cells more

responsive to insulin. Others cause your pancreas to release more insulin into the

bloodstream or block your liver from sending extra glucose into the blood.

Until now, most diabetes diets have tried to compensate for the cells’

resistance to insulin’s action, too. They limited the amount of sugar in your diet.

They have also limited starch (complex carbohydrate) because starch is actually

made from many glucose molecules joined together in a chain. During digestion,

starch breaks down to release natural sugars into the blood. The idea is that if

you do not get too much carbohydrate at any one time, your cells will not be

overwhelmed with too much glucose. For people on medications, typical diet

plans have aimed to keep the amount of sugar or starch fairly constant from meal

to meal and from day to day so the amount of medication required to help your

body process glucose—your daily dosage—can stay the same, too. In short,

these diets have guided you on what, when, and how much to eat.

New research has changed everything, however. We can now use diet

changes to influence insulin sensitivity directly. So, as you will see shortly, the

nutrition prescription has been completely rewritten to take advantage of this

new understanding.

Gestational diabetes is similar to type 2 except that it occurs during

pregnancy. While it typically disappears after childbirth, it is a sign of insulin

resistance, and that means that type 2 diabetes may be around the corner. With

the same sorts of steps that tackle type 2 diabetes, we can often stop gestational

diabetes from ever turning into type 2.

Maturity Onset Diabetes of the Young (MODY). Rarely, a genetic

characteristic can cause the pancreas to produce insufficient insulin. The gene is

typically dominant. The affected individual is very likely to develop high blood

sugars, even though he or she may not be overweight or have insulin-resistant

cells. Because the pancreas continues to produce some insulin, insulin injections

may not be needed. The treatment is similar to type 2.

Prediabetes is the term used when your blood glucose level is higher than

normal, but not high enough for a diagnosis of diabetes. For most people, it

means that you have insulin resistance and are on your way to developing type 2

diabetes, unless you take steps now to improve your health, especially through

changes in your eating habits. This term applies when:

• Your fasting blood glucose level is between 100 and 125 mg/dl (between 5.6

and 6.9 mmol/l).

• Your blood glucose is between 140 and 199 mg/dl (between 7.8 and 11.1

mmol/l) after a 2-hour glucose tolerance test.

• Your A1C blood test is between 5.7 and 6.4 percent.

The good news is that the same steps that help people tackle type 2 diabetes

are also effective for helping people with prediabetes to improve, often

decisively.

Insulin is made in the pancreas, an organ located just behind your stomach that is about the size

and shape of a TV remote control. In fact, remote control is what the pancreas is all about. It

sends insulin into the bloodstream to travel to the cells of your body to help them take in glucose

from the bloodstream. In type 1 diabetes, the pancreas has stopped making insulin. In type 2 and

gestational diabetes, the pancreas is usually able to make insulin, but the body’s cells resist its

action.

GENES ARE NOT DESTINY

Diabetes runs in families, but don’t take that to mean that if one of your parents

has diabetes, a similar diagnosis has to be your fate as well. You can change

things.

Let’s take a look at type 1 diabetes first. Many children are born with genes

that make it possible for them to develop type 1 diabetes, but most of them never

do. In fact, even among identical twins, when one twin has type 1 diabetes, the

other has less than a 40 percent chance of having it.

1

What makes the difference,

apparently, is the environment, particularly the foods the child is exposed to

early in life (e.g., cow’s milk); viral infections; and perhaps other factors.

Genes play a similar role in type 2 diabetes. Many years before diabetes ever

manifests, special tests can detect insulin resistance in young adults who have

inherited a tendency toward type 2 diabetes from their parents. If they eat the

same kinds of foods their parents did, they are very likely headed for a diagnosis.

Abundant evidence shows, however, that changes in diet and lifestyle can cut the

odds that diabetes will occur. When it does occur, diet can dramatically alter its

course.

The point is this: Some genes are dictators, and others are not. The genes for

hair color or eye color, for example, really are dictators. If they call for you to

have brown hair or blue eyes, you can’t argue. But the genes for diabetes are

more like committees. They do not give orders; they make suggestions.

If our genes call for diabetes, we do not necessarily have to listen to them.

We have more control than you might imagine.

EATING PATTERNS FOR DIABETES

If you have diabetes, chances are you were given printed guidelines on what to

eat and what to avoid. Perhaps you have met with a dietitian, and you may have

been referred to a diabetes class. If you are like many people, you may have

found your diet tough to sustain.

For many years, diets for people with diabetes were designed to provide

basic nutrition while also keeping calorie intake and food choices reasonably

stable over the course of the day and from one day to the next, as you saw above.

The idea was that if you had no carbohydrates for breakfast but then had a big

carb-fest later in the day, your blood sugar would change erratically. Similarly, if

you had lots of starchy foods on Monday but went low-carb the rest of the week,

your blood sugar would be all over the map, and your medications could not

keep up with you.

That approach sounds logical, but it was devised before the causes of insulin

resistance were known and has turned out to be of limited value. Many people

have trouble sticking with it. Now that we understand more about what is

happening inside your cells to cause diabetes, we can choose foods more

strategically. That means diet changes that are simpler and more effective, as you

will see in the following chapters.

The American Diabetes Association now gives a thumbs-up to several

different eating patterns, including vegetarian and vegan diets, the semi-

vegetarian “DASH diet,” low-fat diets, low-carbohydrate diets, and

“Mediterranean diets.” However, we now have good scientific evidence that

allows us to see which diet changes really work best over the long run, and soon

you will be putting that power to work.

DRUGS AND MONEY

The diet changes you will read about in this book are powerful. Unfortunately,

the power of nutrition is neglected in many medical practices, and in the process,

diabetes treatment is reduced to a series of prescriptions.

Don’t misunderstand me. Diabetes medications can be lifesaving. They can

reduce your blood sugar and, over the long run, cut your risk of complications.

And if diet and lifestyle changes do not do the job, it can be a serious mistake to

forgo medications. But some doctors and patients view medications as the only

tools at their disposal. The marketing of pharmaceuticals has so dominated

medical practice that many doctors give little more than lip service to diet and

exercise, which can often be dramatically effective.

Open any diabetes journal and you will see expensive advertisements for this

drug and that drug.

If you were to leaf through the mail that floods doctors’ offices, you would

see information about medical courses, symposia, and online educational

programs, all paid for by drug companies trumpeting their products. These

companies cater full dinners to lure doctors to presentations about one or another

application of their drugs. While many doctors find such events distasteful, they

are required to attend medical courses to maintain their hospital or university

affiliations, and drug companies have cornered the medical education market.

At the ADA annual meeting, drug company representatives arrive at the

loading dock looking as if they are preparing to put on an enormous political

convention. They erect huge display booths costing hundreds of thousands of

dollars staffed with armies of sales personnel ready to provide gifts, food,

musical entertainment, and trinkets of all kinds, all designed to woo the

clinicians in attendance.

And, of course, drug companies target consumers directly. Turn on a

television in any American city, and you will soon be inundated by commercials

asking you to speak with your doctor about all manner of medications. They

make diabetes sound almost like fun, and their latest products add to your

modern lifestyle.

You, the drug consumer, are stuck with the bill for all this. A typical diabetes

pill contains a few cents’ worth of active medication, but the retail cost is heavily

inflated by its manufacturer’s promotional expenses and its continued efforts to

find yet another pill that can carve out more of the market share.

The diabetes business is not limited to drugs. Patients need to buy glucose

testing equipment, too. While glucose meters are not terribly expensive,

manufacturers charge a small fortune for the supplies that go with them, much

like the shaving-product companies that give away free razors to sell expensive

blades. The test strips that fit into a typical glucose meter cost about $1 each, and

a person might use anywhere from one to eight strips per day. Add up the costs

of doctor visits, laboratory tests, medication, and glucose monitoring equipment,

and diabetes becomes a phenomenally expensive disease.

It is my hope that as the power of nutritional changes is more fully

appreciated, the commercial aspects of diabetes will take a backseat. The US

government has already invested in research on diet and diabetes, and that

investment will continue to pay important dividends. We must also turn our

attention to putting what we have learned about nutrition to work. That means

encouraging doctors to focus on diet first, pushing insurers to cover dietetic

counseling for patients and their families, educating parents about nutritional

approaches to help prevent type 1 diabetes in their children, and working with

schools to serve healthful meals so children are not sent down the road to

overweight and diabetes, as a great many currently are. These measures could

control the so-called diseases of affluence far more effectively than doctors are

able to at present, dramatically reducing the need for medications in the first

place.

Each person with diabetes has a unique ability to heal and return to health.

This ability differs from one person to the next, but in our studies, we have not

seen age, weight, or any other factor to be a barrier to improvement.

The remainder of this book will show you what I believe to be the most

powerful dietary approach to diabetes that is currently known.

*

The passage of glucose from the bloodstream into the urine led to the technical name doctors use for

diabetes: diabetes mellitus. Diabetes comes from a Greek word meaning “to pass through,” and mellitus is

the Latin word for “honey” or “sweet.”

CHAPTER 2

Reversing Type 2 Diabetes

Remarkably, my research has shown that it is possible to reverse diabetes—to

decrease blood sugar, medication doses, and the risk of complications—and this

chapter will show you how, using surprisingly simple diet changes. I will also

share some surprising new findings about the causes of type 2 diabetes—

changes inside your body’s cells that can be detected years before diabetes starts.

Evidence suggests that switching to a healthier diet has a powerful influence on

the workings of your cells, as you will see.

All doctors and dietitians recognize that if you have diabetes, your body does

not process sugar very well, which is to say that the amount of sugar in your

bloodstream is too high. Researchers learned long ago that if it stays high, you

are at risk for many health problems down the road.

To lower your blood sugar, most medical professionals are likely to prescribe

a diet that includes very little sugar. They will also ask you to limit starchy foods

—such as bread, potatoes, rice, and pasta—because in your digestive tract,

starch breaks apart to release sugar (that is, glucose). It seems to make sense—if

your body cannot handle sugar, you have to be careful about eating too much

sugar and anything that turns into it. Your medical team will also encourage you

to space out your intake of starches and sugars throughout the day—and from

one day to the next—so that it stays fairly even over time. Diabetes diets also

generally cut calories to help you lose weight and limit certain fats to reduce the

risk of heart disease and other complications. That, in a nutshell, is a typical

“traditional” diabetes diet.

It is certainly logical, and some people greatly benefit from following it. The

problem is that for most people, this sort of diet change has only a very limited

effect. Weight loss is usually modest, and the diet alone typically is not enough

to bring blood sugar under control.

Sooner or later, you and your doctor are likely to decide that the “diabetes

diet” is not helping very much, and your doctor will add various drugs. You may

need one, two, or even three different oral medications. Eventually, your doctor

may consider adding insulin injections. And because many people with diabetes

also have high blood pressure or high cholesterol levels, doctors often add

medications to tackle these problems, too. Instead of helping you reduce or avoid

medications, the diet seems to be a stepping-stone on the way to an ever-

increasing list of drugs.

The first glimmer that there might be a better way came from a look at the

prevalence of diabetes around the world. Large population studies showed that

diabetes was rare in Japan, China, Thailand, and other Asian countries. It was

similarly rare in parts of Africa.

These studies also showed something else: People in countries where

diabetes was uncommon were not following anything like a “diabetes diet.”

They did not avoid carbohydrates; they ate starchy foods every day. In Asia and

Africa, rice and other grains, starchy vegetables, bean dishes, and noodles are

staples. In fact, researchers found that people in these countries ate considerably

more carbohydrates than North Americans or Europeans do, yet diabetes was

relatively rare. So were weight problems. While obesity is found in more than 30

percent of American adults, it occurred in less than 1 percent of Japanese adults

following a traditional diet. Heart disease and several forms of cancer were rare,

too. Longevity among Japanese adults was better than that of North Americans

or Europeans.

That is, until they moved to Vancouver—or Seattle, Chicago, Atlanta, or

Washington, DC. For a Japanese adult, a move to North America dramatically

increased the risk of diabetes. Heart disease, obesity, and other problems became

much more common, too.

Now, if you are worrying that I am going to ask you to adopt a traditional

Japanese diet, relax. That’s not a bad idea, but it is not what this book is about. I

raise this international comparison simply to make an important point:

Carbohydrates do not cause diabetes. And a diet that focuses on keeping

carbohydrates out of your diet is not a powerful way to manage—let alone

reverse—the disease. If anything, healthy complex carbohydrates help prevent it.

Think about what happens when an Asian man or woman switches to a

Western lifestyle. Hamburgers, fried chicken, cheese, and other Western fare

come into the diet, while rice and noodles are gradually forgotten. The diet

becomes fattier and much higher in protein, while carbohydrate-rich rice and

noodles and other starchy foods fall by the wayside.

Tragically, that is exactly what is happening. What’s more, Asian men and

women need not leave home for these changes to occur. McDonald’s has come

to them; Burger King, KFC, and other Western eating habits have also invaded

Asia. Meat, cheese, and other greasy foods are displacing rice and vegetables.

As the Japanese diet has become Westernized, the prevalence of diabetes has

exploded. In studies of adults in Japan over age 40, diabetes prevalence was

between 1 and 5 percent prior to 1980. By 1990, it had gone up to 11 to 12

percent.

1

Statistical projections suggest it will rise even further. It turns out that

the genes that allow diabetes to occur are surprisingly common among the

Japanese, but as long as they stuck to their rice-based traditional diet, the disease

was mostly held in check. The diabetes genes lay dormant, like seeds on dry soil.

Once rice fell out of fashion and Western eating habits took hold, the genetic

traits started to show themselves.

So, if people in Asia or Africa who eat lots of carbohydrates have very little

diabetes, and if the disease becomes more and more common as carbohydrates

are excluded from the diet, researchers have had to conclude that a high-

carbohydrate diet is not the cause of the disease. In fact, the culprit seems to be

lurking in our Western diets.

The inescapable fact is that the problem is not carbohydrates (that is, sugar

and starch). The problem is in how the body processes them. If we can repair

your body’s ability to absorb and use carbohydrates, not only can you enjoy

healthy carbohydrate-rich foods without worry, but diabetes itself ought to

improve—perhaps even go away.

A look inside your body will show you what I mean.

A LOOK INSIDE YOUR BODY

Your pancreas, an organ in your abdomen, produces insulin. As you know by

now, insulin is a hormone, and the pancreas sends it into your bloodstream to

travel to the various cells of the body. Like a key sliding into a lock, insulin

attaches to a receptor on the cell’s surface and causes the cell membrane to

permit glucose to enter. Insulin does the same thing for the next cell, and the

next, and the next. It attaches to a receptor on the cell’s surface, opens the door,

and ushers glucose in.

In type 2 diabetes, this system does not work properly. Your pancreas makes

insulin, and insulin travels to each cell, but when it arrives, it has trouble

opening the door. It is as if the lock has somehow become jammed, and the key

no longer works. This is insulin resistance. Yes, the insulin “key” is there, but it

has trouble doing its job. Glucose cannot get into the cells, and it builds up in the

bloodstream.

Imagine the workings of a lock on a typical door. What if someone were to

jam chewing gum into the lock? There is nothing wrong with your key and really

nothing wrong with the lock except that it is now filled with gum. To make it

work again, we need to clean it out.

The new approach to diabetes is based on cleaning out your biological locks.

Our goal is to help your insulin “key” work the way it is supposed to.

THE NEW DIABETES DIET

As far back as the early 1900s, researchers were adjusting people’s diets to try to

improve insulin sensitivity.

2, 3

Over the years, many—like me—have been

inspired by the fact that foods that are commonly eaten in Asia or Africa

somehow help prevent diabetes.

In 1979, researchers at the University of Kentucky studied 20 men with type

2 diabetes, all of whom had been taking an average of 26 units of insulin per day.

The experimental diet included plenty of vegetables, fruits, whole grains, and

beans, so it was high in fiber and carbohydrate. The diet was nearly vegetarian,

with very little animal fat—in fact, very little fat of any kind.

After just 16 days on the program, more than half of the men were able to

stop taking insulin entirely, and their blood sugar levels were lower than before.

4

For the remaining men, insulin doses were cut dramatically. That was an

amazing and rapid result. But the study was short, and the participants lived on

the research ward for its duration. It was unclear whether a similar result would

be seen in people living on their own and preparing their own meals and whether

it would be sustained over the long term.

A study conducted at the University of California, Los Angeles—197 men

enrolled in a 3-week diet change and exercise program—showed much the same

thing. Of this group, 140 were able to discontinue their medications.

5

That was a

great result, and it occurred very quickly. The study’s limitation from our point

of view was that it could not separate the effects of diet from those of exercise.

Both are important, of course, but if we want to track down the best diet for

diabetes, it is important to keep everything else constant while the diet is being

tested.

Several years ago, my research team began a series of studies to see what

diet alone could do. We tested a diet that focused not on limiting carbohydrates

but rather on getting as much fat off the plate as possible. We thought if we

could do that, perhaps we could clean out the “lock” mechanism that opens the

cell doors.

We began with a small pilot study, which I mentioned briefly in the

Introduction. Most of the participants were surprised to see rice, pasta, sweet

potatoes, and beans on the menu and even more surprised that the diet did not

limit carbohydrates at all. No matter how long they had had diabetes or how

nervous they felt about the idea of putting carbohydrates back onto their plates,

we put no limit on carbs at all.

There was also no limit on portions. Most of our participants were

overweight, but even so, we did not ask them to limit portions or cut calories.

What we zeroed in on was fat. We aimed to clean all the grease out of the

participants’ diets. So, instead of bacon and eggs for breakfast, they had to

choose from old-fashioned oatmeal, half a cantaloupe, or whole grain toast. If

they had chili for lunch, it was veggie chili. Instead of pasta topped with meat

sauce, they got meatless marinara. For the duration of the study, we asked them

to set aside animal products completely and stick to vegetarian foods.

Needless to say, if there are no animal products in the diet, there is not a

single drop of animal fat. We kept the use of vegetable oils as minimal as

possible, too. And, in order to isolate the effects of the diet, we asked the

participants not to alter their normal activity patterns; no one was to add exercise

to the regimen. Now, exercise is an important part of any healthy lifestyle, and

ordinarily we would strongly encourage it. But this was a test of the diet alone,

and for scientific reasons, exercise was not to be part of it.

At the end of the study period, everyone weighed in. In just 12 weeks, the

average participant had lost 16 pounds. Their fasting blood sugar had dropped 28

percent. Two-thirds of the participants on diabetes medications were able to

reduce or discontinue them in that short period of time.

6

All this occurred

without any limits on calories, portions, or carbohydrates and without exercise.

These effects were significantly greater than those seen in a control group

carefully following the diet guidelines of the American Diabetes Association

(ADA).

That was impressive. But why did it happen? How does a diet that gives a

green light to pasta, rice, and all the other foods that people with diabetes

thought they had to live without—and one that completely disregards calories

and avoids exercise—cause blood sugar to plummet and weight to easily drop

away?

To answer that question, we designed another study. This one included a

group of women who were moderately or severely overweight but did not have

diabetes. Once again, we zeroed in on animal fat and vegetable oils. Our

participants set animal products aside and kept oils to a bare minimum. And they

were free to implement the diet guidelines in their own way, whether they ate at

home or ate out, so it was a good test of how the diet would work in real life. For

one person, eating out might have meant mushroom stroganoff with steamed

vegetables; for another, it might have been vegetable sushi with miso soup and

salad. As long as they avoided animal products and kept oils to a minimum, they

were free to shape their meals to their liking.

For comparison, we included a control group whose members followed what

you might think of as a typical cholesterol-lowering diet. It cut back on red meat

while emphasizing poultry and fish along with plenty of vegetables, fruits, and

whole grains.

The results were quick and impressive. The vegetarian group participants

lost about a pound per week; after 14 weeks, they had lost an average of 13

pounds, compared to 8 pounds for the control group.

7

by now, it was no surprise that this diet causes weight loss, but we went a

step further. We sent our participants to the laboratory for a glucose tolerance

test, which allowed us to measure how their bodies responded to sugar and how

well their bodies’ insulin was working. Each participant swallowed a dose of

sugary syrup, and we took blood samples every half hour to measure rises in

blood sugar and insulin. From these laboratory data, we were able to calculate

each woman’s insulin sensitivity and track how it changed as the study

progressed.

The results were remarkable. The tests showed that our participants were

physically changing. Based on their laboratory measurements, it was clear that

their bodies’ cells were becoming more and more sensitive to insulin. By the 14-

week point, their insulin sensitivity had improved by 24 percent. In other words,

something about the diet reactivated their natural insulin’s ability to open cell

doors to glucose. What that means, of course, is that the diet was addressing the

fundamental problem we see in type 2 diabetes: It was helping glucose get to

where it belonged.

*

Based on these and other studies, the National Institutes of Health—the

research branch of the US government—decided to fund a new study.

8

Working

with me on the project were researchers from George Washington University

School of Medicine and the University of Toronto and dietitians and physicians

working with the Physicians committee for Responsible Medicine, a nonprofit

organization I founded in 1985.

The study included 99 people with type 2 diabetes. For 22 weeks, 49 of them

followed a diet that was similar to those we had tested earlier. The diet was

vegan—meaning that it included no animal products at all—and was low in fat.

Also, while we placed no limits on the amount of carbohydrates our participants

could have, we encouraged everyone to be selective about the kinds of

carbohydrates they ate. Instead of white bread, we encouraged them to choose

rye or pumpernickel. Instead of baking potatoes, we favored sweet potatoes and

yams. The remaining 50 participants followed a diet based on the ADA

guidelines. Once again, we restricted exercise.

What was happening was that the diet had made their cells more sensitive to

insulin’s action, so they were able to take in nutrients more quickly. Glucose got

out of the blood and into the cells, where more of it could be burned up, so to

speak. These calories are released as body heat rather than being stored as body

fat. Scientists call this the thermic effect of food, and it provides a small extra

edge for weight loss.

Over the ensuing weeks, many participants found their blood sugar falling to

the extent that they had to cut back on their diabetes medications. That was a

happy outcome, but it was not our goal. In fact, we were trying to keep

medications unchanged as much as we could so we could isolate the effect of the

diet on their blood sugar. The combination of the diet and the blood sugar–

lowering drugs was so powerful, however, that many participants had to reduce

their doses or discontinue medications altogether to keep their blood sugar from

dropping too low.

To really gauge what the diet could do, we looked at those participants

whose medications had stayed constant and how the diet affected A1C—the

principal gauge of blood glucose control. The ADA diet had reduced A1C by 0.4

percentage point—a good change. But the vegan diet was three times more

effective. It had reduced A1C by 1.2 percentage points (the average person’s

value fell from 8.0 to 6.8 percent during the 22-week study). That is a stronger

effect than is seen with a typical diabetes medication. The vegan diet also proved

highly effective in reducing body weight and cholesterol.

To put all this in perspective, the landmark UK Prospective Diabetes Study

showed that a 1-point drop in A1C for people with type 2 diabetes lowers the

risk of eye or kidney complications by about 37 percent.

10

This is the effect of

just the A1C drop without considering the ability of the diet to also reduce

cholesterol and blood pressure.

11

In the next chapter, I will show you how you can test this diet to see what it

can do for you. But let’s look a bit closer at the science behind this approach.

TOWARD THE PERFECT DIET

Setting aside animal products and keeping oily foods to a minimum may sound

challenging, but our participants commonly reported just the opposite. One man,

Walter, said, “I’m amazed at how easy it was to adapt to this diet. And I feel

great. Within 2 months, I lost 20 pounds. And the more amazing thing to me is

that my glucose averages have fallen by 30 to 40 points.”

For Mark, the change was “an adventure. I tried new restaurants, new

recipes, and different foods I would never have eaten before. My main goal was

to lose weight, and I’ve lost a good 30 pounds so far. When I started, my fasting

blood sugar was 260 to 360. And it dropped like a rock. Now I’m between 130

and 135. And I don’t get tired in the afternoon like I used to.”

Nancy agreed. She felt totally adjusted to the diet within about 30 days.

“And within 5 months of making the change,” she said, “my blood sugar fell so

much that I was able to stop one of my medications. I have much more energy

and really feel tremendous.”

I will walk you through the diet step by step. If it sounds like a very healthful

diet, it certainly is—and not just for controlling blood sugar.

In 1990, Dean Ornish, MD, a young Harvard-trained physician, discovered a

remarkable feature of a low-fat, vegetarian diet. He tested the diet in individuals

with heart disease and added other healthy lifestyle changes—regular exercise,

stress modification, and smoking cessation. Because the diet contained no

animal products, it had no cholesterol at all and very little fat. After a year’s

time, each patient had a special x-ray of the heart called an angiogram, and Dr.

Ornish’s team compared the results with angiograms done on the same patients

at the beginning of the study. The results made medical history. The patients’

coronary arteries, which had been blocked by years of poor diet, were actually

starting to open again. The difference was clearly visible in 82 percent of the

patients after 1 year. This occurred without surgery or drugs—even without

cholesterol-lowering medication.

12, 13

Other researchers have shown that this same sort of diet change reduces

blood pressure. Apparently, eliminating animal fats reduces the viscosity

(“thickness”) of the blood. That is, the blood becomes less like grease and more

like water, so it easily flows through the arteries, causing blood pressure to fall.

Blood pressure is also reduced by the potassium in vegetables and fruits, and

other characteristics of plant foods augment this benefit.

14

Vegetarians are slimmer, too. The average person who embraces a vegetarian

diet loses about 10 percent of his or her body weight.

These changes would be welcomed by most of us, but if you have diabetes,

they can be lifesaving. This is because, as you saw in Chapter 1, persistently

high blood sugar can attack the blood vessels of your heart, eyes, kidneys, and

legs. What kills most people who have diabetes (that is, those who have not

made the diet changes you are reading about) is damage to their hearts. A diet

that reverses that process—turning the clock backward on heart disease,

reducing blood pressure, and trimming weight—is powerful medicine for

everyone with diabetes, whether type 1 or type 2.

Imagine if your eyes were damaged by the disease. An ophthalmologic

surgeon, laser in hand, would carefully try to repair your tender retinas. But what

if foods could help avert this damage in the first place? A diet change that brings

your blood sugar under control, brings your blood pressure down, and helps

rejuvenate your arteries gives a measure of respite to the tiny blood vessels in

your eyes. It does the same for the tiny vessels that make up the filtering unit in

your kidneys, making it less likely that you will ever need dialysis. And of

course, it works powerfully inside the heart.

Now, do not misunderstand me. I am not suggesting that you should forgo

needed medical treatments and rely on diet alone. But a diet change—if it goes

far enough and begins early enough—can revolutionize your health, dramatically

cut your risk of complications, and even reverse these complications to a degree.

INSIDE THE CELL

In discussing type 2 diabetes, I have described each cell of the body as being

rather like a gummed-up lock. Research has shown this analogy to be

surprisingly apt. Indeed, insulin’s ability to work is blocked by the accumulation

of something within the cells: not gum, but fat.

In the February 12, 2004, issue of the New England Journal of Medicine,

Yale University researchers reported an amazing discovery.

15

They tested young

adults whose parents or grandparents had had type 2 diabetes. All were thin and

healthy, and none had diabetes at that point. But some were insulin resistant,

meaning that when they were given a test dose of glucose, it built up more than

it should have in their bloodstream. The researchers found out why: Inside their

muscle cells were tiny amounts of fat, fat that interfered with insulin’s ability to

work. Their bodies made insulin normally, and it reached their muscle cells with

no problem. Once it got there, though, it did not work properly. The muscle cells

simply could not fully respond to insulin because they contained bits of fat, like

gum jammed in a lock rendering a key useless.

How did this fat get there? Well, muscle cells normally store a tiny amount

of fat, which provides an energy source for physical activity. The amount is

normally quite small, and the fat simply waits for that day when you are much

more active than usual and need a bit of extra energy. For some reason, in these

young people, fat had built up much more than it should have—to levels 80

percent higher than in other young people. The fat buildup had reached the point

where it was gumming up the lock. That is, it was interfering with the cell’s

ability to respond to insulin, and that meant that diabetes was very likely in their

future unless something changed in a major way.

I should emphasize that the fat inside your cells is different from the fat

around your waistline. Even if you are quite slim, you may still be accumulating

fat within your muscle cells. The participants in the Yale study were slim,

averaging only 141 pounds. They were young and healthy. But just as young

people who smoke are setting the stage for cancer decades later, young people

who accumulate fat inside their muscle cells are paving the way for diabetes.

Until now, diabetes diets have not been designed to alter what goes on inside

the cells. Instead, they have been designed to compensate for the problem, so to

speak. Because your cells cannot handle glucose—that is, insulin has trouble

getting glucose into them—the diets limit sugars and foods that contain

carbohydrate, because when carbohydrate is digested, it releases sugars. But

what if a change in diet could actually alter the fat buildup within the cells and

reverse the trend toward gradually worsening insulin resistance?

I believe this is exactly what we can do—exactly what you will do as you

make the diet changes described in this book. But first, a few more details from

inside the cells.

Normally, insulin attaches to receptors on the cell’s surface and signals the cell membrane to

allow glucose to enter. However, if fat, called intramyocellular lipid, accumulates inside the cell, it

interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are

supposed to burn fat, and their failure to keep up with the accumulating fat may be the origin of

type 2 diabetes. Luckily, evidence shows that diet changes can reduce the amount of fat inside

the cell.

TINY FURNACES THAT BURN FAT

There is a term for the tiny bits of fat that build up inside muscle cells. Scientists

call them intramyocellular lipids (intra- means “inside,” myo-is “muscle,” and

lipid is “fat”—literally, fat inside muscle cells). As you have seen, these traces of

fat start accumulating many years before diabetes manifests.

16

Let’s go one step further and look at how the fat builds up. Your cells have

microscopic “furnaces” or “burners” that are supposed to metabolize bits of fat

and convert it into energy. If all is operating normally, fat enters the cell and

these tiny burners use it up. These burners are called mitochondria, and they are

responsible for turning fat or other fuel sources into energy to power your

muscle cells. If you are steadily accumulating fat, that is a sign that your burners

—your mitochondria—are falling down on the job.

In type 2 diabetes, the problem appears to be too few mitochondria. That is,

people with type 2 diabetes have fewer mitochondria than they need to burn up

the accumulating fat. If they had more of these little “furnaces” inside each cell,

things would be very different.

Surprisingly enough, it may be that the number of mitochondria you have

depends on what you eat. Let me describe a second research study.

At Pennington Biomedical Research Center in Baton Rouge, Louisiana,

researchers studied 10 young men. They averaged just 23 years of age; were

reasonably trim, averaging 174 pounds; and were healthy. The researchers put

them on a high-fat diet that drew about half its calories from fats.

17

This is much

more fat than you would want to have in your diet, but it is not far different from

what many people actually eat. After just 3 days on a high-fat diet, the men had

accumulated significantly more intramyocellular lipids, so the first lesson of this

study was that fat builds up quickly. Depending on the foods you eat, you can

pack fat into your cells surprisingly rapidly.

Then the researchers tested the genes that produce mitochondria. Just as you

have genes in your cells that allow you to make bones, hormones, skin, hair, and

all the other structures of your body, you also have genes that serve as blueprints

for mitochondria. It turned out that the fatty foods these volunteers ate did more

than just pack fat into their cells; they actually turned off the genes that would

help burn fat. The genes that produce mitochondria were in fact partially

disabled. It was as if the men’s bodies were trying to avoid burning the fat they

had eaten so they could save it inside the cells for future use.

Imagine what this means: You have eaten fatty foods and, as a result, tiny

bits of fat have accumulated in your muscle cells. This fat interferes with the

normal workings of the cells, including their ability to respond to insulin. If

insulin is unable to work, glucose cannot get into the cells, and it builds up in the

bloodstream. Then, those fatty foods actually seem to disable your genes that

would produce the mitochondria you need to burn up this accumulating fat. Your

ability to eliminate fat inside your cells seems to be slowed down when you eat

fatty foods.

Let me speculate about why all this occurs.

Your body chemistry began to take shape many thousands of years ago, long

before fast-food restaurants and convenience stores ever got their first shipments

of cheese and fryer grease. Our human ancestors did not find fatty foods growing

on trees—or at least not many of them. On the rare occasions when they ate fatty

foods—meat, eggs, nuts, or avocados, for example—their bodies may actually

have tried to save some of the fat from these foods in case they needed it to

power their muscles or food became scarce. Thus, it would not be surprising if a

sudden influx of fat in the muscle cells signals them to turn off the fat-burning

mitochondria and save the fat for future needs. Today, of course, that is the last

thing we want. We want to power up our mitochondria—turn on those little

furnaces to eliminate fat.

Well, can you get rid of this fat? Let’s say you stopped eating fatty foods.

Would intramyocellular lipid start to disappear?

Let me share the results of a startling experiment. At Catholic University in

Rome, Italy, eight patients underwent gastric bypass surgery.

18

The operation is

commonly done as a last-ditch treatment for massive obesity, and for good

reason. What it involves is this: The stomach is stapled so that only a tiny pouch

about the size of an egg is left to receive food. Then the intestine is cut in two.

The first part of the intestine simply lies unused, while the lower portion of the

small intestine is attached directly to the tiny stomach pouch. In this way, the

patient cannot eat much food, and there is much less intestine available to absorb

the nutrients from whatever food is eaten.

After the procedure, the patients were essentially starving. They could eat

very little food at any given meal, and any fats they ate were poorly absorbed

because the first part of the small intestine, which is where fats are absorbed,

was no longer connected to the stomach.

As you might imagine, they lost weight, dropping from an average of more

than 300 pounds (137 kg) to 229 pounds (104 kg) in the first 6 months. That is

not unusual after such drastic surgery. What was striking was the effect on their

cells. The fat inside their muscle cells—their intramyocellular lipid—dropped by

87 percent. And even though they were still overweight, their insulin resistance

had largely disappeared.

I am not recommending that you have this procedure. I am presenting these

findings to make a critically important point: The fat inside your cells is not a

permanent fixture. If the influx of fat stops, the fat inside the cells dissipates, and

when that happens, the cells start to regain their normal function.

Surgery is a drastic solution, but the Italian researchers also tested whether a

low-calorie diet without surgery could deplete intramyocellular lipid—and it did.

Following a 1,200-calorie diet for 6 months, the patients lost about 30 pounds on

average and eliminated about 8 percent of the fat inside their cells. Now, that

modest result came from a diet that focused just on cutting calories rather than

on eating particular types of food, which will be the focus of this program. The

next step is to make the diet more powerful so it works a little more like surgery,

without all the obvious risks of an operation.

Let’s go a step further. At Imperial College School of Medicine in London,

researchers studied a group of individuals following a vegan diet. They

compared the participants to others who were similar in age and body weight but

were not following a vegan diet.

19

When the researchers measured the

intramyocellular lipid in each participant’s calf muscles, they found it was 31

percent lower in the vegans than in the omnivores. It looks as if there is

something about the diet that helps prevent fat buildup in cells.

These studies show—loudly and clearly—that the accumulation of fat in the

cells and all the problems it causes are not simply a matter of genes. Genes do

play a role, but these effects are very much a matter of diet, too, and it can

change dramatically.

In Part 2, you will see how to select foods to address this problem in the

most powerful way possible.

*

The study turned up another particularly remarkable finding. In a laboratory at george Washington

University, we measured the participants’ metabolism—how fast their bodies burned calories. This was

done by measuring how much oxygen they consumed minute by minute and how much carbon dioxide they

produced after being given a test meal (two cans of a standard liquid formula).

After 14 weeks on the experimental diet, it was clear that the participants had a significant increase in

their after-meal calorie burn; their after-meal calorie-burning speed increased by 16 percent.

9

CHAPTER 3

A Revolution in Type 1 Diabetes

If you have type 1 diabetes, the diet changes you will soon learn about can be

lifesaving. No doubt you have heard that type 1 diabetes increases the risk of

heart problems and other complications. When you really take control, however,

all these risks plummet.

Research has proven that you are not powerless against the complications of

diabetes. There is a lot you can do to protect yourself.

The Diabetes Control and Complications Trial did it with medication. The

study was sponsored by the US government and included 1,441 people with type

1 diabetes. Some of the participants took insulin once or twice daily, as is

common practice. The remaining participants were asked to follow a more

intensive program. They took insulin three or four times daily, either by injection

or via an insulin pump. They checked their blood glucose several times a day

and adjusted their insulin doses accordingly. Over 17 years of follow-up, the

extra care these individuals took paid off dramatically. Careful tracking of blood

sugar and medication adjustments lowered the risk of heart problems by 50

percent.

1

Also, although people with diabetes are at risk for eye problems, careful

blood glucose control reduced that risk by 76 percent compared to people on

traditional medical therapy. It cut the risk of kidney problems by 39 percent and

reduced the risk of neuropathy by 60 percent.

2

The study treatment involved medication rather than diet, but it proved a

vitally important point. Many people had imagined that diabetes complications

are simply inevitable; this study showed otherwise. Gaining control over your

blood glucose makes an enormous difference. Now, with type 1 diabetes, you

will need to use insulin to achieve that goal. But diet and exercise offer

additional power that too few people take advantage of. And diet is the focus of

this book.

Also, it is important to understand that blood sugar control—as vital as it is

—is just one part of the equation. Your risk of developing problems with your

heart, kidneys, eyes, or extremities also depends on your blood pressure,

cholesterol levels, and other factors. The goal now is to adjust your diet to

control all of these to the extent that we can, adding medications as necessary

according  to  your  doctor’s  advice.
TOWARD  AN  OPTIMAL  LIFESTYLE
In  type  1  diabetes,  your  greatest  risk  is  to  your  heart  and  blood  vessels.  If  you  do
nothing,   cardiovascular   disease   lies   in   wait.   In   fact,   it   strikes   the   majority   of
people   with   type   1   diabetes.   We   now   have   a   better   understanding   than   ever
before  about  how  to  use  diet  and  lifestyle  changes  to  protect  the  heart,  not  only
for  people   with  diabetes   but  for   anyone.  Chapters  4  and  5   will   cover   how   and
what  to  eat  in  great  detail,  and  Chapters  12  and  13  will  discuss  the  complications
head-on.  In  the  meantime,  here  are  the  keys.
A   healthy   diet.   Follow   the   diet   steps   outlined   in   the   next   chapter.   These
practices  eliminate  cholesterol  and  animal  fat,  keep  fats  in  general  very  low,  and
guide   you   away   from   sugar   and   refined   carbohydrates   and   toward   healthy
complex  carbohydrates.
As  you  will  see,  there  is  a  special  advantage  to  a  vegetarian  diet,  or  I  should
say   a   vegan   diet—meaning   a   menu   that   includes   no   animal   products   at   all.
Dietary  cholesterol  is  found  only  in  animal  products.
*
Animal  products  also  tend  to  be  high  in  the  saturated  (“bad”)  fats  that  tend  to
cause  your  body  to  make  additional  cholesterol,  an  effect  that  is  actually  much
greater   than   eating   cholesterol   itself.   A   plant-based   diet   eliminates   these
problems.  It  has  another  major  benefit  as  well:  It  derives  its  protein  from  plants
rather   than   from   animal   products.   Research   studies   have   shown   that   among
people  with  any  degree  of   kidney  damage,   animal  protein  increases   the  risk  of
further   kidney   deterioration.
3
   On   the   other   hand,   healthy   beans,   grains,   and
vegetables  are  just  what  your  kidneys  ordered.
A  plant-based  diet  does  more  than  reduce  your  risk  of  complications.  It  may
also  reduce  the  amount  of  insulin  you  need.  When  people  with  type  1  diabetes
begin   a   low-fat,   vegan   diet,   many   report   that   their   insulin   requirements   fall
dramatically.   Although   the   reasons   for   this   are   not   entirely   clear,   it   is   a   very
welcome  result.
Please   read   the   next   chapters   very   carefully.   They   will   show   you   how   to
begin.
No  smoking.   If   you   smoke,   now   is   the   time   to   stop.   If   you   have   tried   50
times,  it  is  time  for  try  number  51.  You  can  and  will  succeed.  Ask  your  doctor  to
help  you.
Regular  exercise.  Even  modest  exercise,  such  as  daily  walking,  makes  a  big
difference.   See   your   doctor,   who   will   assess   your   heart,   your   joints,   and   your
overall  health  to  make  sure  you  are  ready  for  exercise.  See  Chapter  11  for  ways

to get started.

Stress management. Stress affects your health directly, causing fight-or-

flight hormones to flood into your bloodstream. In turn, these hormones

typically raise your blood sugar. Stress also disrupts your eating routines and

interferes with sleep.

Getting a handle on stress does not mean stepping back from the challenges

of life. It means finding ways to enjoy life fully without letting stress get out of

control. There are many healthy ways to relax, including meditation, yoga, and

even simple breathing exercises.

As you saw in the previous chapter, Dr. Dean Ornish showed that these four

steps—a healthy vegetarian diet, smoking cessation, regular exercise, and stress

management—can actually reverse heart disease, even without the use of

cholesterol-lowering medications. That is a tremendous benefit. Your doctor may

add medications to your regimen to protect you further.

These lifestyle changes will not eliminate the need to use insulin for type 1

diabetes. But they can help you stay healthy, minimizing the effects of diabetes

on your life.

A NEW UNDERSTANDING OF THE CAUSES OF TYPE 1 DIABETES

Let’s think for a moment beyond improving the health of people with type 1

diabetes. What if we could actually prevent it in the first place? Research over

the past 3 decades suggests that we may already have the ability to prevent many

cases of type 1 diabetes.

If you thought the disease was simply genetic and there was no way to stop

it, read on. Studies of identical twins have set that notion aside. Identical twins,

of course, have exactly the same genes, so they have the same hair color, eye

color, and facial features. If a disease were simply genetic, then both twins

would have it. But type 1 diabetes does not work that way. As I mentioned in

Chapter 1, if one twin has diabetes, the other has less than a 40 percent chance of

developing it.

So, although genes play a role, it is clear that type 1 diabetes is not simply a

genetic disease. Something else triggers it—something in the child’s early

environment.

For many years, researchers have known that type 1 diabetes occurs when

the immune system attacks and destroys the insulin-producing cells in the

pancreas. Your immune system, of course, is your defense against viruses,

bacteria, and cancer cells. It is not supposed to attack your own healthy body

tissues, but that is exactly what occurs in type 1 diabetes.

To understand why this happens, let’s look at a few basics. The complex

defense network of your immune system is made up of specialized white blood

cells. Some of these cells engulf invading germs and digest them. Others make

antibodies—molecules that attach to invading organisms like harpoons and

identify them for other immune cells to attack. If you have type 1 diabetes, your

immune system has made a major error: It has attacked and destroyed your

insulin-producing cells, resulting in what scientists call an autoimmune disease.

But why does it occur? Back in 1992, a team of Canadian and Finnish

researchers reported an important discovery in the New England Journal of

Medicine. Examining blood samples from 142 children newly diagnosed with

type 1 diabetes, they found that each of the children had antibodies that were

primed to attack cow’s milk proteins. These antibodies had apparently arisen in

response to cow proteins in their infant formula, but the antibodies were also

capable of attacking the body’s insulin-producing cells.

4

It turned out that a

portion of the cow’s milk protein was biochemically an exact match for a portion

of human insulin-producing cells. The antibodies that arose to destroy the cow’s

milk protein ended up attacking the children’s insulin-producing cells. The

pancreatic cells were destroyed by “friendly fire.”

This study and others suggested a scenario that could lead to type 1 diabetes.

It has long been known that when a very young infant is fed cow’s milk formula,

some of the milk proteins pass from the digestive tract into the bloodstream.

5, 6

It

is possible that the infant’s immune system recognizes these bovine proteins as

foreign and forms antibodies to attack them and that these antibodies attack not

only the cow proteins but also the insulin-producing cells of the pancreas. This

destructive process is presumably gradual; when nearly all the insulin-producing

cells are gone, type 1 diabetes results. The researchers believed that the mature

digestive tracts of adults would not allow these dairy proteins to pass through the

intestinal wall and into the bloodstream, but in infants, the molecules passed

through more easily.

The study suggested that one way to prevent type 1 diabetes, at least for

many children, might be to avoid exposure to cow’s milk early in life. Needless

to say, in the early 1990s, neither parents nor pediatricians had any idea about

this. Cow’s milk formulas were routinely fed to infants, and they still are. When

children are not breastfed, some sort of formula has to be used. And while some

children are given soy formulas that would presumably pose no diabetes risk,

many are given cow’s milk varieties.

In 1992, when the New England Journal of Medicine report emerged, the

well-known baby doctor Benjamin Spock, MD, and I held a press conference.

We were joined by Frank Oski, MD, director of pediatrics at Johns Hopkins

University, and other nutrition experts. We recommended that parents be given

information about the potential risks of early exposure to cow’s milk. After all,

parents are pushed very hard to give cow’s milk to their children, but they rarely

hear of potential risks it might pose. We called for an end to recommendations

that push milk consumption on children and said that parents should have good

information in order to decide what to feed their children.

The event proved controversial. Most major newspapers and broadcast

channels covered the story. The American Medical Association (AMA) sharply

criticized Dr. Spock and me for casting doubt on the healthfulness of dairy

products. Research teams trying to replicate these findings got mixed results,

with some coming up empty-handed. Still other researchers pointed out that

finding the antibodies required special techniques, without which the antibodies

would remain elusive.

7

Eventually, the American Academy of Pediatrics

convened a work group to look into the matter. Two years later, in 1994, the

group issued a report. Based on more than 90 studies, the group agreed that

indeed, the risk of diabetes can very likely be reduced if infants are not exposed

to cow’s milk proteins early in life.

8

Eventually, the AMA withdrew its

objections.

While Dr. Spock and I felt there was already substantial evidence and good

reason to issue cautions about exposure to dairy products early in life, the

controversy did not end there. There was only one way to know whether dairy

proteins could actually incite the series of events leading to type 1 diabetes: The

theory had to be put to the test. A european team began that process.

TESTING THE DAIRY-DIABETES THEORY

In a pilot study, researchers in Finland, Sweden, and Estonia identified 242

newborns at risk for developing type 1 diabetes—each had a first-degree relative

with the condition. The researchers then encouraged their mothers to breastfeed.

When mothers were ready to wean their infants, the researchers asked half to use

a specially modified baby formula in which dairy proteins were broken up into

individual amino acids—protein building blocks that are too small to elicit an

immune reaction. The other families were allowed to use a regular cow’s milk

formula. The research aimed to see whether avoiding exposure to intact cow’s

milk proteins could reduce the likelihood of developing diabetes.

9

As the years went by, the researchers found that the children who were fed

the special formula were much less likely to develop the dangerous antibodies.

In fact, the risk of developing antibodies to their insulin-producing cells was cut

by 62 percent.

The study was small, only a pilot trial, but it did follow most of the children

through their first 6 to 8 years of life. During those years, several children

developed diabetes. Of those receiving unmodified formula, eight developed the

disease, and in the modified-formula group, five developed it. As it turned out,

two of those five had dropped out of the study right at the start and never

actually received the modified formula. That meant that only three children in

the modified-formula group developed diabetes, compared to eight in the

regular-formula group. The study suggested that the cow’s milk theory may well

be part of the puzzle, but it was too small to be definitive, and the research team

began a much larger test in 2002 involving families in 15 countries.

There were some limitations to this pilot study. First, it restricted dairy

consumption only during the first several months of life. It is not clear whether

later exposure, say, at 8 or 9 months of age, might put some children at risk as

well. After all, it has long been known that very large dairy protein molecules

can sometimes pass from the digestive tract into the bloodstream, even in adults.

The study did not address whether exposure to dairy proteins could trigger type

1 diabetes in children who are beyond early infancy.

Second, the study did not ask breastfeeding mothers to avoid cow’s milk in

their own diets. For decades, we have known that some cow’s milk proteins

ingested by a nursing mother end up in her breast milk. They come from her

digestive tract, are absorbed into her bloodstream, and find their way into the

breast milk, sometimes making babies colicky.

10

Thus, in order to avoid

exposing babies to dairy proteins, it is important to eliminate them not only from

infants’ diets but also from the diets of their breastfeeding mothers.

One last caution about this study: It did not actually exclude dairy products

from the children’s diets. Rather, it used a milk product treated to break up the

dairy proteins. If anything in milk other than these proteins contributes to the

problem, this study would not have been able to detect it. Even so, it was an

important step in coming to understand how parts of an infant’s diet may lead to

diabetes.

The study illuminated other contributors to diabetes, too. Prior evidence had

suggested that viral infections may play a role, and indeed, viruses appear to

have done so for some infants in the milk study. Specifically, viruses seem to

stimulate immune cells, perhaps making them more active against cow’s milk

proteins than they would normally be. Or, cow’s milk proteins may influence the

course of viral infections in some way.

11

The idea is that the interplay between

cow’s milk formula and viruses may put babies at increased risk.

No one knows what the research on milk and type 1 diabetes will ultimately

show. If the theory turns out to be correct, it suggests that avoiding cow’s milk

products, at least during the first several months of life, could greatly reduce the

likelihood of developing this disease.

Needless to say, breastfeeding instead of feeding formula poses no risks for

children. Quite the opposite: Breastfed babies gain many advantages, including

better overall health and even a few extra IQ points, compared to their formula-

fed counterparts. And the most healthful breastfeeding is done when mothers

follow a diet free of foods that can harm their babies.

Other risk factors for diabetes may yet emerge in research studies. And for

children who are already in the midst of an antibody attack, researchers are

studying means of intervening to try to stop the destruction of their insulin-

producing cells.

STAYING HEALTHY

If we are able to prevent diabetes, we will have a very powerful tool at our

disposal. For people who already have type 1 diabetes, there are effective steps

they can take to help them stay healthy. Keeping blood glucose under control is

essential, and stabilizing cholesterol levels and blood pressure protects the heart

and blood vessels. The same sort of diet that is described in this book for type 2

diabetes is likely to be enormously beneficial for people with type 1 as well,

helping them to prevent complications and reduce their insulin doses.

*

It is a good idea to eliminate cholesterol from your diet completely. There is no “good” cholesterol in

foods. Rather, cholesterol in foods always tends to increase your blood cholesterol level. This is in contrast

to cholesterol that is measured by blood tests, which doctors separate into “good” (HDL) cholesterol and

“bad” (LDL) cholesterol, among other forms. HDL cholesterol is “good” because it is leaving the body.

PART 2

The Program

CHAPTER 4

A Powerful New Menu

We are setting our sights on a dramatically better result than previous diets could

deliver—a result that’s possible through a new approach to eating that I will

explain in this chapter. If you have type 2 diabetes, you do not want to cater to

insulin resistance; you want to counteract it. If you have type 1 diabetes, you

want to get your blood sugar under good control, minimize your medications,

and stay in good health. This chapter will show you the principles of

revolutionizing your menu. Then, in the following chapters, I will show you how

to put them to work as you plan your meals.

For type 2 diabetes, our goal is to “clean the gum out of the locks.” As you

recall, the fundamental problem in type 2 diabetes appears to be the

accumulation of tiny amounts of fat inside muscle cells. They make it hard for

insulin to do its job by blocking what is called insulin signaling. That is, they

interfere with the process by which insulin opens the cell membrane to allow

glucose to enter. You need to select foods that reverse this process.

A diet revamp can also help protect your body from the disease process. That

is crucial for both type 1 and type 2 diabetes.

As you will see, these diet changes are far-reaching and powerful. You may

also find, as many of our study participants did, that learning the plan’s

guidelines is a simple process. There are no limits on portions, calories, or

carbohydrates. You will focus on what you eat, so how much you eat generally

takes care of itself. But we are getting ahead of ourselves.

Let’s first look at the menu changes that make the diet so effective. Then, in

the following chapter, I will walk you through various ways to adopt them to

make this diet doable for you.

To reverse the course of diabetes, “clean the gum out of the locks,” and allow

the heart and blood vessels the best chance of reversing any existing blockages,

there are three guidelines.

1. Set aside animal products.

2. Keep vegetable oils to a minimum.

3. Favor foods with a low Glycemic Index.

Now, there is no need to panic. I know this sounds like a tall order. I am

going to walk you through each step to show you the whys and hows. Soon, it

will be second nature. For now, I just want you to understand the principles.

1. SET ASIDE ANIMAL PRODUCTS

There are two possible sources of fat in the diet: animal products and vegetable

oils. This guideline tackles the first of these.

Needless to say, if you are not eating beef, you will not get any beef fat. If

you are not eating chicken, you will not get any chicken fat. Following this

guideline means purging the animal fat from your diet. The program you are

about to start omits meat, dairy products, and eggs.

As you saw in Chapter 2, researchers who measured the fat inside the muscle

cells of people on high-fat diets showed that the fat you eat can rapidly increase

the amount of fat in your cells. Exactly the opposite appears to happen in people

who avoid animal products. As you recall, people following a vegan diet had 31

percent less intracellular fat compared with people on a regular diet.

1

That means

improved insulin sensitivity. That is a great start, and the next guidelines are

designed to carry you further.

You will get another benefit. When you set aside animal products, you do

more than free yourself from animal fat; since animal products are the only

source of cholesterol in the diet, leaving them off your plate also eliminates all

the cholesterol from your diet. As your cells reclaim their health, the rest of your

body does, too.

Instead of eggs and bacon for breakfast, you might have a big bowl of old-

fashioned oatmeal with cinnamon or blueberries, half a cantaloupe, and some rye

toast. Perhaps you might add some veggie sausage or veggie bacon.

For lunch, instead of, say, meat chili, you might have veggie chili or hearty

lentil soup. If you generally go for a burger, you might choose a veggie burger. If

you have dinner at an Italian restaurant, you might have spaghetti with tomato

sauce, wild mushrooms, artichoke hearts, and fresh basil. At a Mexican

restaurant, you would skip the meat taco in favor of a bean burrito (hold the

cheese) or veggie fajitas. At a Chinese restaurant, you could have your pick of

the many vegetable dishes on a bed of rice.

At this point, you may be thinking, “Spaghetti? Rice? Am I allowed to have

these carbohydrate-rich foods?” The answer is yes. Now, I know that people

with diabetes have heard over and over that they must limit rice, pasta, and other

starchy foods. But keep in mind that diabetes—and overweight—has been rare

in countries that have made these foods their staples. The plan does have

guidelines about carbohydrates, but they relate mainly to which ones are the best

choices, not how much you put on your plate. In our studies, we have found that

people who include plenty of healthy carbohydrates in their diets do better, not

worse.

“I can understand omitting beef,” you may say, “but why eliminate chicken

and fish?” Well, the nutritional makeup of these foods may surprise you. They

have significant amounts of fat and cholesterol, and they lack the fiber and

healthy carbohydrate you need.

Chicken, of course, is where chicken fat comes from. Even if you strip away

the skin and eat only white meat, about 23 percent of the calories come from fat.

Much of that fat is the “bad” form—saturated fat, the kind that pushes your

cholesterol upward and worsens insulin resistance.

Fish vary. Some types are lower in fat than chicken, while others, such as

salmon, are quite high. But all fish have fat, and much of it—between 15 and 30

percent—is saturated fat. All fish have cholesterol, too. Some, such as shrimp

and lobster, are much higher in cholesterol, ounce for ounce, than steak.

Of course, some people eat fish precisely because it has fat in it. That is, a

portion of the fat in fish is in the omega-3 form. Omega-3 fats are reputed to

block the formation of blood clots that could lead to heart attacks.

Scientific evidence has not been supportive. In large, carefully conducted

research studies, fish oils have not been shown to protect the heart. They do not

reduce the likelihood of a heart attack or stroke or reduce the risk of dying. They

do not help healthy people who are trying to avert their first heart attack, and

they do not work for people who have already had a heart attack and are trying

to avoid another one.

2, 3

Could the supposed benefits of omega-3s be just a fish story? Well, it is

important to remember that fish fats are mixtures, just as all fats are. Fish oils do

indeed contain some omega-3 fat, but they also contain plenty of saturated fat.

As noted above, from 15 to 30 percent of the fat in fish is plain old saturated fat.

That’s less than in beef (about 50 percent) or chicken (about 30 percent), but it is

considerably more than you need. There is no specific need for saturated fat in

your diet at all.

The load of fat in fish might explain the disconcerting fact that fish

consumption is linked to a higher risk of developing diabetes. In 2009, the

American Diabetes Association reported in its journal, Diabetes Care, that

people who regularly ate fish, but no other meats, had a 4.8 percent prevalence

of diabetes, compared to 3.2 percent for lactoovo-vegetarians and 2.9 percent for

vegans.

4

In other words, having fish in your diet does not help; it actually

increases diabetes risk.

Similarly, Harvard researchers found that people who ate the most fish had a

24 percent higher risk of developing diabetes, compared with those who

generally avoided fish.

5

Finally, if you are looking to lose weight, it is important to note that “good

fats” pack in just as many calories as “bad fats.” That is to say, omega-3s are

every bit as fattening as any other fat or oil. All fats and oils have 9 calories in

every gram, compared with only 4 calories per gram of carbohydrate.

In practice, chicken-and-fish diets are routinely disappointing. We have

carefully tested these diets and found that, even when they are followed very

closely, their ability to reduce LDL (“bad”) cholesterol is only about half that of

a plant-based (vegan) diet, and their ability to control blood sugar or blood

pressure or to help you lose weight is limited, too.

6

Much more effective are diets that eliminate animal products altogether. Our

studies and those of other researchers have shown that plant-based diets cut LDL

cholesterol far more effectively than any other diet approach.

Now, you will notice that when you avoid animal products, your diet is not

just free of animal fat; it is also free of animal protein. That is important because

animal protein can harm the kidneys, and protecting them is a key goal. Protein

from plant sources is the way to go.

If life without chicken or cheese sounds challenging, take heart from the

experiences of the folks who participated in our research. They found the

transition to be smooth. They found tastes they liked better than their old go-to

foods. And within a few weeks, they were very much in charge—not only of

their menus but also of their health. They found that excess weight was already

starting to melt away, their blood sugar was coming under control, their

cholesterol levels were falling, and very soon, many started to cut back on—or

even discontinue—their medications.

What a Difference: Animal versus Plant Foods

FAT (% OF CALORIES) CHOLESTEROL (MG)

Salmon, Atlantic

40

71

Beef, bottom round, lean* 33 86

Chicken, white meat, skinless 23 85

Pork loin, lean 41 81

Trout, rainbow 35 69

Tuna, white 21 42

Apple 3 0

Beans, navy 4 0

Broccoli 11 0

Lentils 3 0

Orange 4 0

Rice, brown 7 0

*Meat servings are 3.5 ounces (100 grams).

SOURCE: USDA, Agricultural Research Service Nutrient Data Laboratory,

https://ndb.nal.usda.gov/ndb/search/list, accessed April 8, 2017.

Ready for a Change

In one of our research studies, half the volunteers were assigned to a low-fat vegan diet, and

the other half were instructed to follow a more conventional diet for diabetes. Since it was to be

an unbiased test, the diet assignment was done by a computer. So the process was random,

and neither the volunteers nor we had any influence over who got which diet. Nonetheless, I

was curious about how the volunteers felt about the two diets, so I asked them. If there had

been an opportunity to choose one of the diets, which one would they have chosen? I expected

most to say they would have chosen the conventional diet—it is familiar to most people who

have been diagnosed with diabetes, and I thought the volunteers might feel a bit of trepidation

about giving up meat and dairy products.

As it turned out, their preferences were just the opposite. The volunteers actually preferred

the vegan diet by about two to one. The reason, I learned, was that many had already been on

a conventional diet and had found it dull and not very effective. Many of them had heard about

the advantages of a vegan diet. Others had relatives who followed a vegetarian or vegan diet,

and they wanted to give it a try.

Both groups embraced their assignments. Some did well on the conventional diet and some

did not. The results with the vegan diet, however, were powerful and consistent.

How Nancy and Vance Did It

How did Nancy and Vance, whom you met in the Introduction, fare with the diet

changes?

For Nancy, the change was a welcome one. She was fed up with the lack of

results from the previous diet she had been given and thought a vegan diet

sounded like a good approach. She wanted to lose weight, and she was sick of

feeling so low on energy. This, she hoped, might be an answer.

Nancy grew up in Minnesota. Her mother was not an especially talented

cook, she says, but her Scandinavian family loved food. Her mother and sisters

all struggled with weight problems.

Like most of our study volunteers, Nancy had already made healthy changes

to her diet over the years. She had stopped eating beef, ate plenty of vegetables,

and had gotten away from fatty dressings, so making the shift was reasonably

easy.

As she began the study, she started her day with oatmeal topped with

cinnamon and fat-free vanilla soy milk. At midmorning, she liked to have a

snack, usually fruit such as apples, bananas, raspberries, blueberries, grapes, or

oranges.

For lunch, she had a hearty vegan soup such as minestrone, vegetable soup,

sweet potato soup, or chili, along with a salad made with fresh spinach;

tomatoes; red, yellow, and orange bell peppers; kidney beans and chickpeas; and

other ingredients. Her afternoon snack was often fruit, rye crackers, baked

tortilla chips with salsa, or hummus and pita bread.

After a long day at work, Nancy had no interest in preparing a gourmet meal,

so her dinners were quick and easy: a veggie burger with frozen mixed

vegetables, which she microwaved. Sometimes she had nothing more than a

bowl of bran cereal. A late-night fruit snack rounded things out.

We gave her group a supermarket tour and provided cooking demonstrations

to introduce everyone to healthful products that might be new to them. Nancy

preferred to keep it simple and started making a large pot of soup to eat all week.

“I am not a cook,” she said. “And I find it very easy to stay on this program.”

Vance usually started his day with oatmeal, either plain or with apples and

cinnamon. He also had toast and fresh fruit. Lunch or dinner was pasta or

burritos along with fresh vegetables and fruits. Sometimes his taste called for

salads, usually dressed up with beans, blood oranges, or other additions.

“I had to learn to read labels,” he said. “It is easy to underestimate the

amount of fat or sugar in a can of food. A label might show 6 grams of fat, and

you might think that means the whole can. But it actually means just one

serving.”

For Vance, the vegan diet was the way to go. “I don’t have the personality

that would let me have just a small piece of chicken or a small piece of beef,” he

explained. “I have to cut it out altogether. For me, this is a lifestyle change.”

THE POWER PLATE

For starters, let me introduce you to the Power Plate, a simple meal-planning

guide that my colleagues and I developed. The idea is simple: Build your diet

from four healthy staples—whole grains, legumes, vegetables, and fruits.

On your plate, these simple ingredients might translate into a hearty sweet

potato chowder, spinach lasagna, Cuban black beans and Spanish rice, lentil and

carrot soup, and endless other possibilities. But let’s first take a look at the staple

foods themselves. These are the ingredients that build healthful meals.

The whole grain group. This group includes brown rice, oats, barley, corn,

and all the products that are made from whole grains: breads, cereals, pasta, and

many others. In countries where grains are staples, diabetes is much less

common than it is in North America and europe. This should be no surprise:

Whole grains are filling but have very little fat and no cholesterol. When

selecting grains, let the Glycemic Index guide you to the best choices.

The legume group. This category includes beans, peas, and lentils. It also

includes the endless array of soy products, from veggie burgers to meatless hot

dogs, tofu, tempeh, miso, and every conceivable kind of deli slice. Legumes are

hearty, high-protein foods with a remarkably low GI. They are rich in calcium,

iron, and cholesterol-lowering soluble fiber. Whether you favor a chickpea salad,

black bean chili, or a soy-based veggie burger or other meat substitute, legumes

are handy and healthy.

The one thing the bean group lacks is good public relations. Its health

benefits have gone largely unnoticed. Nutrition scientists, however, know that

putting these healthy powerhouses front and center on your menu is a great way

to drive down your weight, blood sugar, and cholesterol. The US government’s

National Nutrition and Health Examination Survey showed that people who

included beans in their regular menu weighed, on average, 6.5 pounds less than

people who generally neglected this healthy food group.

7

The trend showed up

in teenagers, too. Teenage bean lovers weighed 7 pounds less and had waistlines

that were nearly an inch slimmer compared with their bean-avoiding peers.

8

Researchers at the University of Toronto confirmed that people who include

a serving of beans, chickpeas, lentils, or peas in their daily routine are indeed

thinner and have lower levels of LDL (“bad”) cholesterol.

9, 10

If you are new to bean dishes, go easy at first, keep portions modest, and

cook them thoroughly. They are likely to cause some gassiness until your

digestive tract adapts.

The vegetable group. Each member of the vegetable group is robustly

healthful. The green vegetables—asparagus, broccoli, spinach, kale, Swiss

chard, and many others—are packed with iron and, except for spinach, high in

absorbable calcium. Orange vegetables—carrots, yams, and butternut squash,

among others—are loaded with beta-carotene, a cancer fighter. Be generous with

them.

Instead of the neglected little pile of overcooked vegetables some people

park on their plates, have two or even three different vegetables with your

dinner. One of my favorite combinations is “orange plus green,” as in mashed

butternut squash and broccoli. Sometimes I cook them up fresh, and other times,

I simply use frozen. The colors contrast, as does the sweetness of the squash

with the heartier flavor of broccoli. You do not have to be a gourmet chef. Even

the most hurried person has time to open a package of frozen vegetables and

steam or microwave them.

These foods are loaded with vitamins and minerals, are very low in fat, and

like all plant foods, have no cholesterol at all.

Virtually all have healthy low GIs. The main exception is baking potatoes, so

favor sweet potatoes instead.

The fruit group. Fruits are loaded with vitamins and, of course, have

essentially no fat or cholesterol. Many people with diabetes imagine that because

fruits are sweet, they will raise blood sugar. The fact is, though, that nearly all

fruits—apples, bananas, blueberries, cherries, clementines, oranges, peaches,

pears, and most others—have low GIs.

For a simple and beautiful dessert, combine blueberries with chopped

mango, papaya, or banana. You’ll think of many other great combinations.

How many servings should you have from each group? You can vary your

serving sizes as much as you like. If you prefer Mediterranean cuisine, your

plate may be rich in vegetables and pasta. If Asian food is your thing, your plate

may hold generous portions of rice or other grains. If you love Latin American

foods, you might go for bean dishes. If you come from a typical North American

background, you will probably want a variety of all four. In the next chapter, I

will show you some easy, delicious ways to get started.

It goes without saying that the recommended foods do not include meat,

dairy products, eggs, or greasy fried foods.

Grapefruit interacts with medications

Surprising as it sounds, if you are on certain medications, you may need to avoid grapefruit.

11

A serving of grapefruit or a glass of grapefruit juice can measurably increase the blood

concentrations of drugs you may be taking, to the point of toxicity. Here’s how it works: Let’s

say you were to swallow a cholesterol-lowering drug, like atorvastatin (Lipitor). Normally,

enzymes in your intestinal tract and liver will inactivate some of it, reducing the amount that is

actively circulating in your blood. This is entirely normal, and your dose was determined with

that in mind.

But grapefruit knocks out these drug-limiting enzymes. As a result, you end up with more of

the active drug in your bloodstream. About half of all oral medications are metabolized by these

enzymes, and even one serving of grapefruit has an effect that lasts all day.

For cholesterol-lowering drugs, this is an issue for atorvastatin (Lipitor), simvastatin (Zocor),

and lovastatin (Mevacor), but not for pravastatin (Pravachol), rosuvastatin (Crestor), or

fluvastatin (Lescol), because they are metabolized differently.

Grapefruit does the same for dozens of other drugs. So if you have a taste for grapefruit,

check with your doctor about how it might interact with any medications you are taking. The

same effect comes from limes, Seville oranges (used to make marmalade), and pomelos, but

not from typical navel or Valencia oranges. The problem occurs only with oral medications, not

injectables.

Other Permitted Foods

• Fat-free salad dressings and other fat-free condiments

• Coffee (with fat-free nondairy creamer, if desired)

• Occasionally, alcoholic beverages

• Rarely, sugar, nuts, seeds, dark chocolate (made without milk), full-fat soy

products such as tofu, tempeh, soy cheese, etc.

Foods to Avoid

• Meats, poultry, fish, eggs (whites and yolks), and all dairy products (regular

and fat-free), including milk, yogurt, cheese, ice cream, cream, sour cream,

butter, etc.

• Added oils, such as margarine, salad dressings, mayonnaise, cooking oils,

etc.

• Fried foods, such as potato chips, french fries, onion rings, doughnuts, etc.

• Avocados, olives, and peanut butter

• Foods with high GIs, such as white bread or white potatoes

Vitamin B

12

and Vitamin D

Although foods will give you most of the nutrition you need, two supplements

are important: vitamin B

12

and vitamin D. Vitamin B

12

is essential for healthy

nerves and healthy blood, and vitamin D is important for your bones and may

reduce cancer risk. All typical multivitamins contain both and are very

convenient. But because multivitamins also have ingredients you may not want

(e.g., iron and copper), you can instead just pick up these two vitamins at any

drugstore or health food store. You’ll find more details in Chapter 10.

Soup Nirvana

Walter arrived at one of our research meetings to announce that he had found the perfect

lunch. His local supermarket stocks a line of soups from the Tabatchnick company that happen

to come in several low-fat vegan varieties, such as black bean soup, split pea soup, and

vegetarian chili. With simple, natural ingredients, a serving has about 200 calories and just a

gram or two of fat. They are available in both regular and low-sodium versions. Since they are

frozen, they keep more or less indefinitely and can be microwaved to make a meal in minutes.

There are also many other great brands, including Dr. McDougall’s, Health Valley, and

Amy’s, that are easy, quick, and healthful.

Healthier Substitutes for Dairy Products

It may surprise you to learn that some of the biggest sources of fat are lurking in

the dairy section. Milk, cheese, and ice cream once enjoyed a healthful

reputation that few people questioned, but that has changed. It has become clear

that these foods are actually the largest source of saturated (“bad”) fat in the diet,

and also contribute cholesterol, animal protein, and, in the case of fat-free

varieties, a big load of lactose sugar.

Here’s the lowdown on dairy, followed by the good news about how easy it

is to replace it.

Dairy fat. Cow’s milk derives, believe it or not, 49 percent of its calories

from fat. That is a lot by any standard. You may imagine that 2 percent milk is

much lower in fat. Not so. That 2 percent figure refers to fat content by weight,

which is deceptive because it is thrown off by milk’s water content. When you

drink a glass of milk, your body absorbs that water. What matters for your health

is how much fat you are left with. Nutritionists look for the percentage of

calories that come from fat because that figure is unaffected by water content. It

turns out that for 2 percent milk, about 35 percent of calories come from nothing

but fat.

What is particularly worrisome about milk, though, is the type of fat it

contains. Most of it is saturated fat, the very kind that is linked to insulin

resistance and raises cholesterol levels. Dairy products are actually the leading

source of saturated fat in the diet.

Typical yogurt, ice cream, and sour cream products are high in fat, too.

Cheese is loaded with it. Many brands derive about 70 percent of their calories

from fat.

Dairy sugar. Fat-free dairy products have had their fat removed, but what’s

still there may surprise you. When the fat is skimmed away, the predominant

nutrient in milk is actually sugar—lactose, the dairy sugar.

The lactose molecule is a combination of two smaller sugars, glucose and

galactose. Approximately 55 percent of the calories in fat-free milk come from

lactose. People who quite rightly avoid sodas and other sugary drinks because of

their sugar content will want to be aware that milk products are a major source

of sugar, too.

Lactose, of course, is the sugar that causes digestive upset for many people.

Lactose intolerance is a normal condition that occurs when the enzymes that

allow babies to digest mother’s milk naturally start to dissipate. When these

enzymes are gone, lactose passes through the intestinal tract undigested. In the

lower intestinal tract, bacteria start to ferment the sugar, causing gas, cramps,

and diarrhea. Lactose intolerance was once thought to be an abnormality but is

now known to be the biological norm. The symptoms come on gradually,

sometime   after   early   childhood,   and   they   are   simply   a   sign   that   you   have
successfully  passed  the  age  of  weaning.
Dairy  proteins.  These  proteins  have  come  under  scrutiny  for  their  potential
contribution  to  type  1  diabetes,  as  described  in  Chapter  3,  but  they  are  implicated
in  many  other  health  concerns  as  well.  Animal  proteins  appear  to  accelerate  the
gradual   loss   of   kidney   function   that   can   occur   in   diabetes.
12
   Plant   sources   of
protein—beans,   grains,   vegetables,   and   soy   products,   for   example—do   not
appear  to  cause  this  problem.
People   who   have   migraines   often   report   improvement   when   they   avoid
certain  foods,  and  milk  and  other  dairy  products  are  often  at  the  top  of  the  list.
The  same  has  been  reported  for  some  cases  of  rheumatoid  arthritis.  The  problem,
it  appears,  is  not  the  fat  or  lactose,  at  least  not  for  these  conditions.  The  trigger
seems  to  be  the  dairy  proteins.
Dairy   products   are   linked   to   other   health   problems   ranging   from   acne   to
prostate   and   ovarian   cancer.   It   is   the   latter   issue—cancer—that   has   gotten   the
attention   of   the   medical   community.   Two   large   Harvard   studies   and   several
studies   from   other   countries   have   shown   that   milk-drinking   men   have   a
significantly   higher   risk   of   prostate   cancer   compared   with   men   who   generally
avoid  dairy  products.
13–16
  In  trying  to  explain  this  association,  researchers  have
pointed  fingers  at  milk’s  hormonal  effects,  as  well  as  potentially  harmful  effects
of  its  high  calcium  and  phosphate  content.
17
  For  ovarian  cancer,  the  evidence  is
mixed,  with  some  studies  showing   higher  risk   among  milk   drinkers  and   others
showing  no  increased  risk.
18,  19,  20
milk’s   selling   point   has   been   the   calcium   it   provides.   There   are,   however,
better  calcium   sources  and   more  effective  ways  of   maintaining  strong   bones.  I
will  go  into  more  detail  about  this  later  in  the  chapter.
Making  better  choices.  People  who  avoid  dairy  products  find  no  shortage  of
great   substitutes.   Health   food   stores   and   regular   supermarkets   stock   soy   milk,
rice   milk,   almond   milk,   and   many   others.   They   come   in   regular,   calcium-
fortified,   and   low-fat   varieties   and   in   plain   vanilla,   chocolate,   and   strawberry
flavors.  You  will  want  to  choose  those  lowest  in  fat  and  sugar.  Calcium-fortified
juices   have   arrived   on   the   market,   too.   Of   course,   none   of   these   is   necessary.
After  the  age  of  weaning,  the  only  beverage  that  is  actually  biologically  required
is  water.  Not  soda,  not  juice,  not  milk—just  pure  water.
There  are  many  delicious  nondairy   ice  cream  substitutes  made  from   soy  or
rice  milk.  In  many  cases,  however,  the  main  reason  they  are  so  delicious  is  that
they  contain  added  sugar.  Your  taste  buds  can  be  easily  seduced  by  these  treats,
but  your  body  would  be  far  better  off  with  a  bowl  of  strawberries.

Alternatives to Eggs

There are just two problems with eggs: the yolk and the white. The yolk is where

cholesterol lurks, with around 200 milligrams in a single egg. That’s similar to

an 8-ounce steak.

The yolk also holds the fat, about 5 grams per egg. Egg white has problems

of its own, since it is essentially pure animal protein. As you know by now,

animal protein can present problems for your kidneys, and you are better off

with plant protein.

Can there really be all that fat, cholesterol, and animal protein inside a single

egg? Certainly. Keep in mind that when an egg hatches, a baby chick emerges.

That chick’s body—legs, wings, skin, feathers, internal organs, and everything

else—was formed from what was inside the egg when it was laid. So it was

loaded with cholesterol and other things you do not want. Like all animal

products, eggs have no fiber at all and no complex carbohydrate.

There are plenty of great ways to replace eggs, whether you are hooked on

scrambled eggs for breakfast or baked goods that include eggs. Try these

substitutes.

• If a recipe calls for just 1 or 2 eggs, leave them out. Add a couple of extra

tablespoons of water for moisture.

• Egg replacement powders are available in many health food stores.

• Use 1 heaping tablespoon soy flour or cornstarch plus 2 tablespoons water to

replace each egg in baked products.

• Try an egg-size piece of mashed tofu in place of each egg.

• Half a mashed banana can be used in muffin and cookie recipes, although it

will provide its own flavor.

• For meatless loaves and veggie burgers, use any of the following to bind the

ingredients together: tomato paste, mashed potato, moistened bread crumbs,

or rolled oats.

• For a breakfast dish to replace scrambled eggs, scrambled tofu has become

popular. Tofu has a texture very much like egg white and takes on the flavor

of whatever it is cooked with. Be wary of products promoted as no-

cholesterol egg replacements; many are simply egg whites with various

added ingredients.

2. KEEP VEGETABLE OILS TO A MINIMUM

Oils creep in everywhere, it seems: cooking oils, salad oils, vegetable oils used

in baking and in snack foods. Vegetable oils do enjoy a better reputation than

animal fat, and indeed, they have less saturated fat—the kind that raises

cholesterol levels. But we still want to keep all oils to a minimum. Here is why.

First, as we saw above, all fats and oils are loaded with calories. They have 9

calories per gram, which is more than twice the calorie content of carbohydrate

or protein (4 calories per gram). Thus, when it comes to calorie content,

vegetable oils are as fattening as lard. All fats and oils are in fact equally

fattening.

Second, if your goal is to regain as much insulin sensitivity as possible, you

will want to eliminate not only animal fats but also added vegetable oils.

Cleaning the animal fat out of your cellular “locks” does no good if you are

going to clog them with vegetable grease. Here are the sources of these oils.

Fried foods. French fries, potato chips, onion rings, and other fried snacks

are essentially sponges carrying grease from the deep fryer to your body fat

stores.

Added oils. Typical salad dressings and margarines have lots of fat.

Oils used as ingredients. Many packaged foods and sauces include

significant amounts of oil.

Oils used in sautéing. Many recipes begin with the instruction to sauté

onions, garlic, or other ingredients in oil. Some restaurants use oil almost as a

staple.

There are easy ways to avoid all that grease.

• Steer clear of fried snacks such as potato chips and french fries.

• Top salads with fat-free dressings, lemon juice, balsamic vinegar, or

seasoned rice vinegar.

• Use nonstick pans.

• Steam-fry onions, garlic, or vegetables in water or another cooking liquid

instead of sautéing the traditional way.

• Steam vegetables.

• In place of poured oils, consider using cooking spray. If you use just a quick

spritz, the amount of added oil is trivial.

• Use fat-free nondairy coffee creamer.

• Read package labels. Look for products with no more than 3 grams of fat per

serving or with a percentage of calories from fat of below 10 percent.

When it comes to avoiding greasy foods, some people are eager to make an

exception for olive oil. It seems natural and even chic. But think for a second

about how factories manage to fill a bottle with oil. They take an enormous

number of olives, discard their fiber and pulp, and leave you with the fat.

Gram for gram, olive oil has the same number of calories as beef fat, chicken

fat, and other fats and oils—that is, 9 calories per gram. No other food is more

calorie dense. While olive oil contains a great deal of monounsaturated fat,

which has little or no effect on cholesterol, it also contains saturated fat (about

14 percent), the kind that increases cholesterol and worsens insulin resistance. It

does not matter how expensive the oil is or how “extra virgin” it may be. It still

has more calories and saturated fat than your body is designed to process to

maintain optimal health.

There are, of course, traces of natural vegetable oils in vegetables, fruits,

beans, and grains, but you need not worry about them. Your body does need a

tiny amount of fat, and plants provide it naturally. We run into problems when

oils are concentrated, as they are in fried foods, oily sauces, and recipes with

added oils.

A few plant foods, such as nuts, seeds, olives, avocados, and some soy

products, are naturally high in oil. If you are trying to lose weight or tackle

diabetes, you will want to avoid them.

What about Good Fats?

There are two types of fat your body actually needs. Their technical names are

alpha-linolenic acid and linoleic acid. These terms are not important; you will

never see them on an ingredients list. What is important to know is that you need

only a tiny amount of them. The body’s need for these essential fats is no more

than 2 to 3 percent of your daily calorie intake.

Where do you find them? Beans, vegetables, and fruits are very low in fat

overall, but the traces they do contain are relatively rich in “good” fat—that is,

alpha-linolenic acid. This is the basic omega-3 fat that your body uses to produce

other good fats. Nuts, seeds, and soy products contain larger amounts. Linoleic

acid is found in many plant foods, too.

Some people boost the omega-3 fats in their diets. If you are doing this, be

careful: All fats, good and bad, are equally fattening, and many contain things

your body does not need. Fish oil, for example, contains plenty of saturated fat

along with its omega-3s.

The best way to get the right kind and amount of fat in your diet is to skip

animal products, fried foods, and oily food products and get your nutrition from

vegetables, fruits, beans, and whole grains.

Does it really matter whether or not we avoid animal products and added

oils? Absolutely. A typical North American or European diet might provide 80 to

100 grams of fat per day, or even more. Switching from beef to chicken and fish,

keeping portions modest, and limiting added oils will trim this to about 60

grams. But setting animal products aside and avoiding added oils can drop this

number to close to 20 grams. In the process, your cholesterol intake, which

would be well over 200 milligrams per day on an unmodified diet, will drop to

zero. Every cell in your body will thank you.

3. FAVOR FOODS WITH A LOW GLYCEMIC INDEX

You will find this third guideline very useful. The glycemic index (GI) is a

handy tool that was invented by David Jenkins, MD, PhD, DSc, a physician and

researcher at the University of Toronto.

21

It is simply a number that indicates

how rapidly any given food releases sugar into the bloodstream. A food with a

high GI releases sugar into the blood quickly.

One example is white bread. If a molecule of carbohydrate in bread was

greatly magnified, it would look like a string of beads. Each bead is a molecule

of sugar (glucose). In your digestive tract, these beads separate and pass into

your bloodstream.

With white bread, this process is quick. The string of beads rapidly

disintegrates, and the individual glucose molecules race into your bloodstream.

If you were to check your blood sugar after eating the bread, you would see the

result. White bread has a high GI, meaning it has a pronounced effect on your

blood glucose.

In contrast, pumpernickel bread has a low GI.

*

Its “beads” come apart more

slowly, passing into the bloodstream bit by bit. It has much less effect on your

blood sugar.

In a nutshell, high-GI foods tend to have a greater effect on your blood sugar,

and low-GI foods have less effect.

I should mention that when researchers measure the GI of individual foods,

they test volunteers who do not have diabetes, so a food that does not raise their

blood sugar very much could raise yours somewhat more. However, the point of

the glycemic index is to allow us to rate foods—to compare one against another

—so we can choose the best ones.

If you were to do an online search for information about the glycemic Index,

you would soon discover a mind-numbing array of tables from a variety of

sources, none of which agree with each other. That is because the GI of any food

can vary depending on the brand, how it was prepared, and other factors. So,

let’s keep things simple. Here is all you need to know about the GI:

Glycemic Index at a Glance

• White and wheat breads are high GI. Rye and pumpernickel are better

choices.

• Table sugar is high GI. Fruits are better. They give you a sweet taste with a

suprisingly low GI.

• White baking potatoes are high GI. Sweet potatoes are lower.

• Most cold cereals are high GI (especially if they have a toy inside the box).

Oatmeal and bran cereals are better.

And here are a few more tips, for extra credit:

• Beans and their relatives (lentils, peas) are always low GI.

• Green leafy vegetables can also be considered low GI (although they have so

little starch that their GIs typically have not been calculated).

• Pasta is a low-GI food. Because pasta is compacted (unlike bread), it digests

slowly and releases its natural sugars only gradually. More on this below.

• Barley, bulgur, and parboiled (converted) rice all have a low GI value.

Now, if you have type 2 diabetes, any food with carbohydrate in it will push

your blood sugar up to a degree. In fact, a rise in blood glucose after a meal is

normal, and if your cells are insulin resistant, it takes a bit more time for glucose

in your bloodstream to pass into your cells. This does not mean, however, that

you should avoid foods that contain carbohydrate. What it means is that you will

want to take steps to reduce your insulin resistance, as outlined in this chapter.

Among carbohydrates, the best are those with a low GI.

The reason I mention this is that sometimes people with type 2 diabetes shun

carbohydrates. They avoid rice, beans, pasta, and all the rest and load up on

chicken, fish, and eggs because these foods have no carbohydrate. But over the

long run, they find their blood sugar does not improve; their level gets worse, so

they need more and more medicine. It makes sense when you think about the

fact that these foods contribute a load of fat and aggravate the accumulation of

fat in cells—more gum in the locks, so to speak. Greasy meals today mean

insulin resistance tomorrow.

It may surprise you to learn that pasta has a low GI. It does, particularly if it

is served al dente, that is, not overcooked. Of course, pasta is made from wheat

flour, so you may think it would spike your blood sugar in the same way as

wheat bread. But that is not the case.

Pasta actually gives us a little lesson in why some foods have a high GI,

while the GI of others is low.

Let’s say we are making bread dough. We add a bit of yeast to the flour to

make the bread rise. The yeast causes many tiny air pockets to form, which is

what makes bread different from, say, a shingle. Now, as you eat the baked

bread, your stomach acid and digestive enzymes enter those air pockets and

rapidly break the molecules of flour into individual sugar molecules that then

pass from your digestive tract into your bloodstream. Even whole wheat bread,

with shreds of fiber remaining, is easy pickings for digestive enzymes—they

have no difficulty entering the air pockets and digesting the starch in the bread.

pasta is different. It is not made with yeast, so it has no air pockets. If bread

is like a pile of tiny twigs, ready to ignite with a single spark, pasta is like a cord

of logs—it is much more compacted and “catches fire” more slowly. Even if you

chew pasta thoroughly, there is no way it can digest as rapidly as bread—and

that’s why it has a lower GI.

The take-home lesson is that processing foods—pulverizing grains into flour

or using yeast to make dough rise, for example—starts the digestive process

before you even put the food on your plate. An intact grain is slow to come apart

and release glucose into your bloodstream, while a heavily processed grain is

likely to disintegrate quickly. Thus, old-fashioned oatmeal, which consists of

whole oats, has a low GI. But quick-cooking oatmeal is made by slicing the oat

grains into fragments. That allows it to cook faster and to digest faster—which

means a higher GI.

If you would like to look up the GI of individual foods, you can take a look

at a Web site established at the University of Sydney in Australia:

glycemicindex.com. Just type in the name of the food, and all the testing results

will appear.

“Does it really matter?” you may be asking. “Can it really make a difference

if my oatmeal is old-fashioned instead of instant, or if I bring beans, green leafy

vegetables, and barley soups into my life?” Jennie Brand-Miller, PhD, of the

University of Sydney, answered that question by analyzing the combined results

of 14 studies on the glycemic index that included a total of 356 participants. She

found that choosing low-GI foods reduces hemoglobin A1C by 0.3 to 0.4

percentage point. In some studies, the difference was as much as 0.6 point.

23

Studies showed a similar benefit for both type 1 and type 2 diabetes.

This advantage is over and above that of the other diet changes you are

making. As you will remember from Chapter 2, the combined diet changes

described in this book—avoiding animal products, minimizing oils, and eating

low-GI foods—added up to an A1C drop of 1.2 percentage points, on average, in

our research. That average includes people who did not have very far to drop as

well as some participants who started with A1Cs in the 9 to 10 percent range and

dropped several percentage points. These results are stronger than any single

drug is likely to bring. For some people, that is all it takes to return their A1C to

the normal range.

TWO IMPORTANT SUPPLEMENTS

Fruits, vegetables, beans, and grains provide the healthy nutrition you need.

Eating these foods, you are much better nourished than you would be on a

meaty, dairy-filled diet, because these healthy, plant-based foods are rich in fiber,

vitamins, and other plant-based nutrients, while helping you skip unhealthful fats

and cholesterol. Even so, there are two supplements that are important for you to

know about.

Vitamin B

12

. Vitamin B

12

is essential for healthy nerves and healthy blood

cells. If your B

12

level runs low, you could have nerve symptoms that are

permanent. But this vitamin is not made by animals or plants. Rather, it is

produced by bacteria. How does this substance get from bacteria to the human

body? Some have suggested that before the advent of modern hygiene, there

were traces of bacteria in the soil, on vegetables and fruits, on our fingers, or in

our mouths that provided the tiny traces of vitamin B

12

that we need. Whether

that was ever true, it is certainly not a reliable source today. Bacteria in animals’

intestinal tracts produce vitamin B

12

, and traces of it end up in meat and other

animal products. The problem with these sources is that along with it come

cholesterol, fat, and animal proteins. B

12

is also added to some foods, as you will

sometimes see on the package labels of breakfast cereals, soymilk, nutritional

yeast, and other products. The best source is a vitamin B

12

supplement, which

you will find at any drugstore or health food store, and you should take it daily.

The dose is not especially important, because all common brands have more than

the recommended daily allowance, and even high doses of B

12

do not appear to

be dangerous.

Vitamin D. Technically, vitamin D is not a vitamin at all. It’s actually a

hormone produced by sunlight on your skin. Once activated in your liver and

kidneys, it helps you absorb calcium and helps protect your cells against cancer,

among other functions.

If you get plenty of sun, you do not need any vitamin D in your diet. But if

you do not get regular sun exposure, a vitamin D supplement is important. A

reasonable daily dose is 2,000 IU.

PUTTING THE RIGHT FUEL IN YOUR TANK

Now we have covered the basics, the three guidelines that work together to help

you regain control: avoiding animal products, keeping oils to a minimum, and

favoring low-GI foods.

These guidelines work together. Meeting one of them is not enough. For

example, jelly beans can be vegan, and they are low in oil. Because they are

essentially solid sugar, though, they have a high GI and will spike your blood

glucose.

Similarly, a snack cake loaded with butter can have a very low GI because

butter contains no carbohydrate and may even slow the absorption of glucose

you eat. But the snack cake is not vegan, nor is it low in fat. It will contribute to

insulin resistance, and you want to steer clear of it. The low GI is not a reason to

eat it if it does not meet our other criteria.

The three guidelines together are a powerful combination. Nancy’s A1C was

8.3 percent at the beginning of our study. As she began the healthy diet changes,

it rapidly slid under 7.0, even while she reduced her medications. For Vance,

initial A1C testing showed a value of 9.5 percent, but as the weeks went by, it

dropped and dropped and dropped. By the study’s conclusion, his A1C was a

healthy 5.3 percent.

Now, before we plan out your breakfast, lunch, and dinner, let me show you

how these three principles translate into changes inside your body. Just as a car

performs dramatically better when it has the fuel it was designed for, your body

performs far better when you give it the foods it needs.

Increased insulin sensitivity. As you know by now, evidence shows that a

diet change can have a quick and decisive influence on the amount of fat inside

your cells. As the amount of fat drops, your cells become more and more

sensitive to insulin, allowing your blood sugar to come down. If your insulin

resistance was previously worsening and your medication doses increasing, the

process begins to reverse.

This can happen remarkably quickly. In fact, it can happen so quickly that it

is essential, if you are using insulin or any drug that increases insulin secretion

(for example, glipizide, glimepiride, glyburide, nateglinide, or repaglinide), that

you be in close touch with your doctor. As your cells regain their insulin

sensitivity, you will become more and more like a healthy person who is taking

drugs he or she no longer needs.

The combination of a healthy diet and the drugs you have been taking can

drive your blood sugar down to healthful levels and then below them, to

hypoglycemia. In other words, your blood sugar can fall too low, which can be

dangerous. Your doctor will lower your medication doses or even discontinue

your medications as necessary, which will solve the problem. Now, do not throw

your medicines away on your own. Your doctor will guide you. And do not be

frightened by this return to health. It is a wonderful feeling to discover that your

insulin sensitivity is improving day by day. When your doctor says it’s time to

cut back on medication or stop a drug altogether, it is as if time is moving

backward.

Chapter 7 has important details on how to prevent and treat hypoglycemic

episodes. Please read it carefully before you change your diet.

Easy weight control. If you have been hoping to lose weight, that process

has just begun. On average, the diet you are beginning causes a weight loss of

about 1 pound per week. As time goes on, it adds up to an impressive change.

“How does this work?” you may ask. How can you lose weight if you are

paying no attention at all to portion sizes, calories, and carbohydrates? There are

three main reasons.

First, the foods have very little fat, so you are eliminating the main source of

unwanted calories.

Second, the vegetables, fruits, beans, and whole grains you are bringing into

your diet give you a healthy dose of fiber, which is filling enough to turn off

your appetite a bit sooner than would happen without them. On average, each 14

grams of fiber cuts about 10 percent off your calorie intake. A person who

normally eats 2,000 calories per day and then starts to add an extra 14 grams of

fiber daily will tend to feel full after eating 1,800 calories.

24

Third, these foods cause a slight boost in your after-meal calorie burn.

Normally, you burn calories faster after a meal due to the processes of digestion.

Our studies have shown that a low-fat vegan diet increases this after-meal burn,

giving you an extra edge.

25

I will go over this in more detail in Chapter 6. For

now, just enjoy the weight control that is kicking in on its own.

Losing excess weight feels great, of course, but weight loss improves your

insulin sensitivity in addition to the effects of the diet change itself.

Easy cholesterol control. If you have had a cholesterol problem, the

program you are now beginning is far more powerful than typical cholesterol-

lowering diets. This should be no surprise. Your new diet is not low in

cholesterol; it has no cholesterol at all. It also has no animal fat, which is

important because animal fat (like other sources of saturated fat) encourages

your body to make cholesterol. They are all gone now. You have replaced them

with cholesterol-lowering oats, soy, and other botanical magicians, as you will

see in more detail in Chapter 12.

Your arteries are starting to breathe a sigh of relief. The damage of diabetes

is done to the arteries, for the most part, leading to problems in your heart, eyes,

kidneys, and nerves. But now, you are inhibiting that process, and bringing your

cholesterol level down is part of it. You are following the kind of diet used in

programs to reverse heart disease.

Again, do not throw your medications away and cancel your doctor

appointments. Your doctor can size up your heart health and track your progress.

Reversing symptoms. A team of California researchers used a low-fat vegan

diet, combined with exercise, in a group of 21 people with type 2 diabetes, all of

whom had painful neuropathy—the nerve symptoms that arise as the nerves are

damaged. In just 2 weeks, 17 of the 21 reported complete cessation of their nerve

symptoms, and the remaining 4 had noticeable improvements.

26

So our research

team did a test of a low-fat, vegan diet alone—without exercise—and found that,

indeed, it can improve nerve function and reduce neuropathy symptoms.

27

other researchers have found that some of the changes in the eye—exudates

in the retina—that sometimes occur in diabetes start to improve or even

disappear when people make a healthy diet change. The loss of protein through

the kidneys can also diminish. You will find more details on all of these in

Chapter 13.

FIRST STEPS

One of the things we have carefully tested with this program is how people feel

about it. Bottom line: Although you will be making major changes in your menu

that are designed to bring you uncompromised good health, this is perhaps the

easiest diet change to stick with over the long run. Partly, that is because it is not

a “diet.” It is a different way of regarding food—a much better way of thinking

about and enjoying it. Also, you will never go hungry and never tease yourself

with minuscule portions of foods you love.

Let me show you the steps that make it that way. For the moment, you are

not actually going to change anything. I just want to walk you through the steps

that will get you started.

Step 1: Check Out the Possibilities

Before you jump into a new way of eating, take a week and check out a few

recipes and new food products. Look through the next chapter for ideas. You will

find a great many possibilities to get you started. If you rarely cook and tend to

eat at restaurants, the next chapter will have many tips on things you can look

for.

Your goal is to identify healthy breakfasts, lunches, and dinners that you

really like. That means meals that meet all of our guidelines (no animal products,

minimal vegetable oils, and low GI) and appeal to your tastes.

Remember that this new way of eating does not mean making a new dish

every night. William Castelli, MD, former director of the Framingham heart

Study, used to say that most of us tend to stick to our favorite meals. We may

have four or five different dinners we like, and we pick from that repertoire night

after night. All you need to do is to find healthy meals that suit your tastes, and

you are set. A week is more than enough time to do that.

Step 2: Pick 3 Weeks

Some people like to ease their way gradually into a healthier diet pattern. If you

are among that group, go ahead and take your time getting to know healthier

foods. But I advise a different approach. Mark a 3-week period on your calendar

when you plan to embrace this program. Before you reach your start date,

identify meals that fit our criteria and appeal to you. When the start day arrives,

commit yourself completely for 21 days.

As I tell our research participants, this is not the time to stick your toe in the

swimming pool; it’s time to jump in. Really do it. Make it all low-fat vegan, all

the time. There are two reasons for this.

First, it gives you fast results. If you have a healthy meal on monday and

another on Saturday, your body will not notice any difference. But if you do it at

every meal, gains come quickly. Give yourself a chance to see how it feels to be

on as perfect a diet as possible.

The second reason is that a diet change really is like getting into a swimming

pool. If you ease your way into the water bit by bit, it is a painful process. But if

you plunge in, very soon you see that the water feels fine. Let me explain.

Did you ever switch from whole milk to fat-free milk? If you are like most

people, that first glass of fat-free seemed watery and maybe even discolored.

After a couple of weeks, though, you became totally used to the lighter taste.

Before long, whole milk seemed thick and distasteful.

Now, I am not suggesting that fat-free milk is a health food. As you have

seen, there are good reasons to avoid it. But when you lighten your diet, your

tastes rapidly change. Very soon, you come to prefer the new, healthier taste.

You will find that your taste buds have a memory of about 3 weeks, and

jumping into the diet change allows them to adjust quickly. Instead of pining

over the unhealthy foods you have left behind, you will be surprised to find that

you miss them very little.

If a 100 percent diet change sounds like a tall order, let me make it a bit more

approachable. You do not need to commit to it forever; you just need to give it a

try. At this point, there’s no need to swear off bacon double cheeseburgers,

pledge your loyalty to oatmeal, or make any other daunting promises. Just give it

3 weeks. During that time, really do it 100 percent, and you will get a good sense

of what the diet will do while still keeping all your options open.

GET TO KNOW TRANSITION FOODS

Modern technology has brought us plenty of modern annoyances (ringing cell

phones, crowded freeways, and junk e-mail), but once in a while, it’s actually

useful. The food industry has managed to mimic unhealthy foods with more

healthful varieties.

The hot dog, long reviled by nutritionists, gained a measure of respectability

once food scientists figured out how to transform soybeans into a frankfurter.

Veggie hot dogs, veggie burgers, and veggie sausages debuted in health food

stores but are now sold everywhere. Even deli salami, turkey, chicken, and

bologna slices have soy or wheat counterparts that look and taste very much like

the real thing, with zero animal fat and cholesterol.

These foods are hardly the pinnacle of fine dining, but they are practical. If

you have children, they are an absolute gift. If you saw what goes into a real hot

dog, it would become the last thing you would want to see heading for your

child’s mouth. But a veggie version is something you can bring home with pride

—and your kids will love them. These products help you through the transition

to a broader range of healthy foods.

Soy milk has arrived big time. Once, buying soy milk meant shopping at a

health food store that was dingy and dark. The cashier was wearing a tie-dyed

shirt, his name was Sunshine, and folk music was playing in the background.

Well, those days are gone. Health food stores are big businesses that know a

thing or two about customer service. Regular supermarkets stock dozens of

flavors of soy milk, along with rice milk, almond milk, oat milk, and other

varieties, too, and people from all walks of life enjoy them.

As you shop for meat and dairy substitutes, take a look at the labels. When

you check the ingredient lists, you will see that some products are not quite as

vegan as you might like because they include egg whites or dairy proteins.

Choose the vegan versions, and look for those that are lowest in fat.

COMPLETE NUTRITION

When you follow the nutrition guidelines in this chapter, your diet is likely to

improve dramatically.

28

Not only will you skip all the animal fat and cholesterol,

you will get much more of the healthy nutrients your body needs: soluble fiber to

cut cholesterol, healthy vitamins to reduce cancer risk, potassium to lower blood

pressure, and antioxidants to knock out free radicals, to name a few.

Even so, you are making a big change, and you are likely to wonder whether

you are missing out on anything. Let me offer a word of reassurance. If you

choose your meals from a variety of whole grains, legumes, vegetables, and

fruits and take my advice about vitamin B

12

and vitamin D, above, you will have

your bases covered.

here’s where the healthy nutrients are on your plate.

Protein. Your body uses protein to build and repair body tissues. Proteins are

made up of small molecules called amino acids. All the proteins in your skin,

muscles, bones, and internal organs are built from various combinations of about

20 different amino acids.

A healthy diet of beans, grains, vegetables, and fruits provides all the protein

you need. In fact, you are better off getting protein from plant sources. While

animal protein can be hard on the delicate tissues of the kidneys, plant proteins

appear to be free of this problem. They are also free of the risks of calcium loss

and kidney stones associated with animal protein.

29

Animal protein tends to

cause calcium to pass through the kidneys and into the urine. In the process,

calcium is not only lost, but it ends up in your urinary tract, where it can cause

stones.

In years past, some nutritionists believed that vegetarians needed to carefully

combine various foods in order to get adequate protein. The idea was that foods

from plants might be missing one or more amino acids, so only combining foods

in certain ways could ensure that you got them all. This notion was set aside long

ago. The Academy of Nutrition and Dietetics’ official position statements make

it clear that plant-based diets provide plenty of protein without combining foods

in any particular way.

30

If, for any reason, you wish to increase your protein

intake, turn to the bean group. You will find extra amounts of protein in soy

products, such as tofu, tempeh, and soy milk, and in wheat derivatives (e.g.,

seitan) used to make meat substitutes.

Calcium. For many people, calcium and milk are almost synonymous. They

think that milk will build strong bones and protect against fractures later in life.

Research has shown, however, that milk’s benefits are, for the most part, a myth.

Studies do not show much benefit for the bones from drinking milk. How can

that be? Well, only about one-third of milk’s calcium is absorbed by the body.

The other two-thirds simply passes out with the wastes. In addition, milk

contains animal protein and sodium, both of which tend to increase calcium loss

through the kidneys.

Do not misunderstand me here—you need some calcium in your diet, but it

should come from healthful sources, namely green leafy vegetables and beans.

While there is somewhat less calcium in broccoli than in milk, the absorption

fraction—the percentage that your body can actually use—is higher for broccoli

and nearly all other greens than for milk. There is one exception: Spinach is high

in calcium, but the absorption fraction is very low.

Greens and beans will give you the calcium your body needs. If you are

looking for extra calcium for whatever reason, you can find plenty more in

fortified juices and soy milks.

To maintain calcium balance, however, it is important not only to take in an

adequate amount but also to minimize losses. Animal protein causes your body

to lose calcium through the kidneys, and it can be measured in the urine. Studies

of high-protein diets, such as the Atkins Diet, dramatically demonstrate the

losses: Such diets increased calcium loss by more than 50 percent.

31

It is also

important to limit sodium (salt) and get vitamin D from either sunlight or

supplements. Vegetables and fruits promote bone strength for reasons that are

not entirely clear, and exercise gives your bones a reason to live. It is a strong

determiner of bone health. Finally, it is also important to avoid tobacco, since

smoking increases fracture risk.

Iron. Iron is a double-edged sword. You need iron to build hemoglobin,

which your red blood cells use to carry oxygen from your lungs to your body

tissues. But too much iron can be toxic. It can increase the risk of heart problems

and may even worsen insulin resistance.

Iron encourages the production of unstable molecules called free radicals,

which can damage your body’s delicate tissues and are linked to heart disease,

cancer, and even certain aspects of the aging process.

The most healthful iron sources are the same foods that bring you calcium:

beans and green leafy vegetables. They are rich in iron but carry it in a special

form called non-heme iron. Your body easily absorbs this form when it’s in need

of more iron, but the iron passes harmlessly out of the body when you have all

you need. In contrast, meats contain heme iron, which is like an uninvited guest

at your party: It barges in whether you need it or not. Over the long run, meat

eaters tend to accumulate too much iron.

If you are anemic, do not rush out and buy iron supplements, or worse, add

lots of meat to your diet. Instead, work with your doctor to find out what kind of

anemia you have and why it occurred. Anemia can be a sign of kidney disease; it

can be caused by certain drugs; and it can be a sign of blood loss from your

digestive tract caused by gastrointestinal irritation or even colon cancer. It is

essential that you be evaluated and treated appropriately.

If you do need extra iron, turn first to greens and beans. Vitamin C–rich

foods, such as fruits and vegetables, increase the absorption of iron from the

other foods you eat, and avoiding dairy products helps, too. They are very low in

iron and actually reduce its absorption from your digestive tract.

Zinc. Zinc plays important roles in immune function, wound healing, and

many other biological functions, but as with iron, you can have too much of a

good thing. The most healthful sources include legumes, nuts, and fortified

breakfast cereals (e.g., Post Grape-Nuts, bran flakes, and granola).

Fat. Good fats, bad fats, and too much fat—how do we make sense of it all?

The most important fat fact is this: Your body’s actual fat requirement is

minuscule, as you saw earlier. Most people in Western countries get many times

the needed amount. With meats and dairy products front and center in their diets,

they not only get too much fat overall, they also get the wrong kind—saturated

fat, which boosts cholesterol and aggravates insulin resistance.

Nuts, seeds, avocados, olives, and full-fat soy products are also high in fat.

Although they are low in saturated fat, the overall amount is high, and you

should limit these foods accordingly.

As you also saw earlier, most vegetables, fruits, and beans contain very little

fat, and what they do have is a healthful mixture, including traces of the essential

fats alpha-linolenic acid and linoleic acid.

If, for any medical reason, you are increasing your oil intake, healthful

sources of omega-3 fats include walnuts, soy products, flaxseed, and, in

concentrated form, flax, linseed, canola, and walnut oils. Health food stores even

sell omega-3 supplements (e.g., DHA) drawn entirely from botanical sources.

They are a better choice than fish oils. Omega-6 oils are also sometimes used for

health conditions such as arthritis, usually in the form of evening primrose oil,

borage oil, black currant oil, or hemp oil. They should be thought of as

medicinal supplements rather than as foods.

In the next chapter, you will get started with your new program, and then, in

Chapter 7, I will show you how to track your progress.

*

The glycemic index of a food is determined by feeding a portion containing 50 grams of carbohydrate to

10 healthy people after an overnight fast. Blood glucose is tested at 15- to 30-minute intervals over the next

2 hours, and the result is compared to feeding the same amount of glucose (or, in some cases, white bread).

A GI below 100 means the food has less effect on blood sugar, compared to glucose. A higher number

means the test food has agreater effect.

22

CHAPTER 5

How to Get Started

By now, you understand the principles for building a healthful diet and are ready

to get started with foods that will tame your blood sugar, help you lose weight,

and go a long way toward lowering your blood pressure and cholesterol. But you

are no doubt asking, how do I start? And will it be easy? Will I be able to stick

with it?

Let me put your mind at ease. The two-step system described in the last

chapter makes this very easy. You just take a week to “check out the

possibilities” and then do a 3-week “test drive.” Let’s revisit this in more detail:

STEP 1: CHECK OUT THE POSSIBILITIES

Take a week, and see which healthy foods you like best. You are not going to

eliminate anything. Rather, you’ll try out new products, new recipes, and new

tastes, and perhaps get reacquainted with a few healthy tastes you may have

forgotten.

Take out a sheet of paper and jot down the headings “Breakfast,” “Lunch,”

“Dinner,” and “Snacks.” over the next 7 days, write down—in each of the four

categories—foods you like that meet the three guidelines set out in the previous

chapter. In a nutshell, we are choosing foods that are:

Vegan. They contain no animal products. This means no meat, fish, dairy

products, or eggs—not even a little bit. The idea is to clean the animal fat,

animal protein, and cholesterol out of your diet. If you skipped to this chapter

and are wondering why these steps are important, please go back and read the

preceding chapter.

Low fat. You will use little or no added oil and omit other fatty ingredients.

If you are reading labels, choose foods with no more than 3 grams of fat per

serving.

Low glycemic index. You will favor low-GI foods. This means generally

avoiding sugar, white bread products, baking potatoes, most cold cereals, and a

few other foods. Most other vegan foods are fine. Certain foods have an

especially low GI value: beans and other legumes, green leafy vegetables, most

fruits, barley (which is great in soups), and the many foods that are made from

them. Surprisingly, pasta has a low glycemic index, unlike other wheat products.

Healthful Breakfast Ideas

Under “Breakfast,” your list may well be similar to what you are eating already.

Here are a few suggestions.

• Hot cereals such as oatmeal or other whole grain cereal with cinnamon,

raisins, and/or applesauce (no milk)

• Cold cereals such as bran flakes with fat-free soy or rice milk and/or berries,

peaches, or bananas

• Melon, cantaloupe, bananas, or any other fruit

• Rye or pumpernickel toast topped with cinnamon (no butter or margarine)

If you like extra protein, try these.

• Veggie sausage

• Veggie bacon

• Scrambled tofu

• Breakfast burritos filled with “refried” beans, lettuce, and tomato (no egg or

cheese)

• English baked beans or chickpeas

• Pumpernickel bread with hummus

Here are a few thoughts about some good breakfast choices.

Oatmeal. Most of our research participants make old-fashioned oatmeal a

part of their morning routine, and for good reason. Oats are rich in soluble fiber

—the kind that gets creamy in water and removes cholesterol from your body.

(Wheat and rice are high in insoluble fiber.) But that humble bowl of oatmeal

does more than that. It helps bring your blood sugar under control, and its high

fiber content helps you lose weight.

An additional advantage comes from what oats do not have: cholesterol and

animal fat. A bacon-and-eggs breakfast has a strikingly large amount of both.

Generally speaking, old-fashioned oatmeal is better than instant or 1-minute

varieties, although even these quick-cooking versions are far better than bacon

and eggs. The more intact the grain, the lower the GI, and the longer the cereal

keeps you satisfied. See “Old-fashioned oatmeal” for tips on making the perfect

bowl of hot oatmeal.

For an extra blood sugar–lowering effect, top your bowl with cinnamon (see

“Which Supplements Should You Take?” for details about how cinnamon affects

blood sugar). Or add raisins, berries, or just about any fruit or mix of fruits you

like, but set the milk and sugar aside. Within just a day or two, you will break the

habit of adding these unnecessary and unhealthful toppings. If you just cannot

imagine oatmeal without milk, splash on some soy milk or rice milk; you will

skip the animal fat and cholesterol of cow’s milk.

Most dry cereals have a high GI, but oatmeal is in a good GI range, as is bran

cereal. They will keep you full and satisfied and help keep your blood sugar

steady.

Veggie sausage or bacon. Regular sausage and bacon are loaded with

cholesterol and fat and are among the most unhealthful foods on anyone’s

grocery list. But if you are unable to imagine breakfast without these meats, food

manufacturers have come to your rescue with vegan versions, and most

supermarkets and all health food stores now carry several varieties. If they are

new to you, think of them as a liberal interpretation of the original; they are tasty

and high in protein. Read the package labels, and choose those that omit animal

ingredients (some are made with egg white, which is concentrated animal protein

that you want to avoid) and are as low in fat as possible.

Scrambled tofu. Tofu is almost identical to egg white—it has little flavor of

its own but quickly takes on the flavors of whatever spices or sauces it is cooked

with. Scrambled tofu is a great substitute for scrambled eggs—it has all the taste

but no cholesterol, animal fat, or animal protein. Supermarkets sell scrambled

tofu seasoning mixes, usually shelved near boxed rices or in the health food

section. Just follow the package directions.

Breakfast burritos. No time for breakfast? Breakfast burritos to the rescue.

You buy them frozen, pop them in the microwave, and in a couple of minutes,

you have a hearty, healthy breakfast. Health food stores and most regular grocery

stores stock a variety of frozen burritos made with beans, tofu, tomatoes, and

other ingredients. You can also make your own, of course, perhaps on the

weekend, and refrigerate or freeze them so they are handy for those busy

mornings.

Bagels. If bagels are your thing, favor pumpernickel bagels, which have a

lower GI than white bagels.

A Few Things Not on the Breakfast Menu

Just to state the obvious, eggs are off the list. A single egg has around 200

milligrams of cholesterol—similar to an 8-ounce steak—plus a load of saturated

fat, the kind that tends to raise cholesterol. The white of the egg presents a big

dose of animal protein that you want to avoid. As you know, getting your protein

from plant sources is better for your kidneys and your long-term bone health.

Skip eggs and egg replacements such as Egg Beaters, which are made from egg

whites.

Of course, breakfast meats are off the list, too, including turkey sausage as

well as pork or beef varieties. They all have cholesterol and animal protein.

Forget doughnuts, Danishes, and muffins. To see why, set one on a napkin

for a few minutes, then look at how much grease has leached out. That grease is

just waiting to fatten you up, boost your cholesterol, and worsen your insulin

resistance.

A Balanced Breakfast

You may wish to start your breakfast with a high-protein food such as veggie

sausage and follow it with a starchier food like oatmeal with cinnamon and

raisins or a sweet food such as fruit. It’s not that you need extra protein; there is

actually plenty of protein in any typical meal built from vegetables, grains, and

beans. Here’s why starting with a high-protein food can be helpful.

Starchy or sugary foods naturally increase the production of serotonin—the

same feel-good chemical that is boosted by antidepressants such as fluoxetine

(Prozac) and sertraline (Zoloft)—in the brain. Now, that’s a nice benefit, but for

some people, the result is postbreakfast drowsiness. In fact, some people actually

use starchy foods as a remedy for insomnia. A high-protein food blocks the

serotonin-producing action, boosting your energy. Any high-protein food will

do: veggie sausage, veggie bacon, scrambled tofu, beans, or even a spoonful or

two of chickpeas—the kind you’d normally throw on a salad.

So, during this first week, explore the various breakfast possibilities and jot

down your favorites.

Sample 1-Day Menu

Breakfast

Veggie sausage

Rye toast

Oatmeal with cinnamon and raisins

Sliced cantaloupe

Lunch

Green salad

Split pea soup

Hummus sandwich on rye bread with sliced tomato and cucumber

Dinner

Spinach salad with cherry tomatoes

Angel hair pasta with tomato and mushroom sauce

Steamed broccoli

Snacks

Apples, oranges, bananas

Healthful Lunch Ideas

Okay, let’s move on to lunch. Here are a few ideas, but you will no doubt have

many more.

Salads

• Garden salad with fat-free dressing, lemon juice, or soy or teriyaki sauce

• Three-bean salad

• Pasta salad

• Black bean and corn salad

• Grain-based salad, such as noodles, couscous, bulgur, or rice

Soups

• Minestrone

• Mixed vegetable

• Lentil

• Mushroom barley

• Black bean

• Vegetarian chili

• Split pea

• Instant and prepared soups are okay as long as they are low-fat and free of

animal products.

Sandwiches/Wraps

• CLT: sliced cucumber, lettuce, and sliced tomato on rye bread with Dijon

mustard. Or use veggie bacon, rather than cucumber, if you like.

• Hummus on a whole wheat pita with grated carrots, sprouts, and sliced

cucumber

• Sandwich made with fat-free meat alternatives such as veggie turkey,

bologna, or pepperoni slices or barbecued seitan (wheat gluten), plus your

favorite sandwich veggies on rye bread

• Black bean dip, bell pepper and tomato slices, and lettuce wrapped in a

whole wheat tortilla

• Italian eggplant sub: baked eggplant slices, pizza sauce, and mushrooms on a

whole grain sub roll

• Black bean and sweet potato burrito with corn and tomatoes

Extras

• Fresh fruit

• Chickpeas

• Cut-up vegetables

Here are a few more details on good lunch choices.

Salads. Salads vary from the simple lettuce-and-tomato variety to pasta

salads, three-bean salads, Asian salads, fruit salads, and many others.

If you start with salad greens, regular lettuce is fine, but do not shy away

from baby spinach, arugula, and other greens. Add cucumber, artichoke hearts,

and tomato slices and by all means, chickpeas, kidney beans, or other legumes to

your salad. They provide plenty of nutrition and are great at holding your blood

sugar steady.

For convenience, supermarkets carry commercial three-bean and four-bean

salads in jars, which are ready when you are. Many stores also have well-stocked

salad bars.

When you choose dressings, look for fat-free vegan varieties, which are easy

to find at many supermarkets.

Soups. Soup is a great lunch starter, or a big bowl of hearty soup can be your

lunch. Loaded with vegetables, beans, lentils, barley or other grains, and

wonderful flavors, soups are satisfying and wonderfully healthful. If you cook

up a big pot on the weekend, you will be ready for the week ahead.

If you are looking for convenience, Manischewitz brand dried soup mixes

are time-savers. Just add them to boiling water and let them simmer. If you like,

add tomatoes, green chiles, or any frozen or fresh vegetables. Stir a tablespoon

or two of nutritional yeast into each bowl for a savory touch. If you add extra

carrots, tomatoes, frozen vegetables (e.g., broccoli, kale, cauliflower, or green

beans), and spices, you will turn your soup into a stew.

If you’d like to let someone else do the cooking, your supermarket has an

endless variety of canned and frozen soups. You need to be selective, but you

will find plenty that meet our requirements. Lentil, minestrone, and vegetarian

vegetable are good choices. Tabatchnick frozen soups offer generous servings of

split pea, mushroom barley, and other flavors with simple ingredients and

virtually no fat.

Instant soup comes in a cup and just needs hot water. You might keep a few

cups in your desk drawer for emergencies.

To have homemade soup anywhere, pick up an insulated bottle, such as a

Thermos, so you can just fill it with soup and take it to work. Your co-workers

will wish they had done the same.

One caveat about prepared soups: Some manufacturers overdo it with salt, so

it pays to choose lower-sodium brands. Aim to keep your total daily sodium

intake to less than 1,500 milligrams.

Sandwiches. Sandwiches are quick and portable, and with the enormous

variety of ingredients available these days, they can be healthful, too.

Start with a lower-GI bread, such as rye or pumpernickel. Try any or all of

the following fillings.

Hummus is a Middle Eastern dish that has become popular in North

America. It is made from chickpeas and spices and has a texture vaguely

reminiscent of peanut butter but a milder flavor. Unfortunately, many

commercial brands are too high in fat, but who needs them? With a food

processor, it takes only about 5 minutes to make your own, and a big batch will

last for days.

Meatless deli slices have all the taste of bologna, sliced turkey, or ham with

none of the animal fat or cholesterol. They are sold at all health food stores and

many supermarkets, and they make great sandwiches. You can find them next to

the vegetarian hot dogs, which are also great choices. As always, choose lower-

fat brands.

Veggie burgers are easy to make, and commercial brands are widely sold in

stores and restaurants. Try a few different brands, and find your favorites. Favor

those that are lowest in fat.

A BLT made with veggie bacon, lettuce, tomato, and mustard is a great

choice. My own keep-it-simple sandwich is a CLT, made on toasted rye bread

with lettuce, sliced cucumber and tomato, sometimes a vegan deli slice or two,

and topped with Dijon mustard.

Speaking of condiments, mustard is fat-free; make it your spread of choice.

Most mayonnaise spreads are just the opposite—they are loaded with fat. There

are now many vegan mayos on the market, but they are not necessarily low in

fat. Check the labels.

Frozen meals. The TV dinner has grown up. The amazing variety of frozen

foods, plus the convenience of microwave ovens, makes it easy to eat healthful,

tasty foods. Some favorites include vegan enchilada or burrito dinners and pizza

or pasta dishes.

If lunch means dining out—or perhaps fast food—see Chapter 8 for healthful

restaurant choices.

Healthful Dinner Ideas

There is a limitless array of healthful foods for dinner, whether you like to cook

or not. Many people enjoy cooking, but many others feel too busy or just cannot

be bothered; they tend to choose simple and convenient foods or eat out.

Personally, I fall squarely into the second group.

The good news is that both temperaments do very well in this program. Here

are a few ideas for starters.

• Pasta marinara: Many commercial sauces are fine. Choose those lowest in fat

and free of cheese and other animal products. Add some mushrooms,

artichoke hearts, or broccoli or spinach (prepared fresh or frozen), and you

will be set.

• Beans and rice: Try Cuban black beans with salsa, vegetarian baked beans, or

“refried” beans.

• Soft tacos: Start with a whole wheat tortilla and add beans, lettuce, tomato,

and salsa.

• Chili: Vegetarian boxed versions are fine.

• Veggie lasagna: Use low-fat tofu to replace the ricotta, and add layers of

grilled veggies.

• Rice pilaf, Spanish rice, or packaged rice dinners: Many commercial brands

are fine, but omit the butter.

• Fried rice and vegetables: Use a nonstick pan and season this meal with low-

sodium soy sauce.

• Fat-free veggie burgers: Read the labels and choose those lowest in fat and

free of cheese and other animal products.

• Fajitas: Lightly sauté sliced bell peppers, onion, and eggplant in a nonstick

pan and add fajita seasonings.

• Stew made with chunky vegetables in a savory sauce

• Mushroom stroganoff

Our job for now is not to make you into a chef, but simply to make a realistic

1-day menu of foods you really will eat and enjoy.

It pays to think “international.” many cuisines from around the world have

great choices, whether you make them yourself, have them at restaurants, or buy

them frozen: Mexican bean burritos, Italian pastas and bean soups, Chinese

vegetable and rice dishes, Japanese vegetable sushi with miso soup and salads,

Indian curries, Thai dishes, Ethiopian cuisine, and many others. These foods take

advantage of the rich tradition of plant-based diets in many countries.

If your idea of dinner is sending out for pizza, it can still be vegan and low in

fat. Just ask for all-vegetable toppings, such as mushrooms, peppers, onions,

sun-dried tomatoes, and capers. Hold the cheese and ask for extra tomato sauce

instead. If you are making pizza at home, you can add veggie pepperoni or other

deli slices if you like. For a cheesy taste, sprinkle on some nutritional yeast.

A Balanced Dinner

A good way to make sure your dinner is well balanced is to fill about a quarter of your plate with

a legume dish. That means beans, peas, or lentils. So you might choose baked beans, a bean

burrito, or black-eyed peas, for example. These foods are rich in protein, soluble fiber, and

minerals and have wonderfully low GIs.

Next, fill another quarter of your plate with a starchy food such as brown rice, a yam, or

pasta. Starch is an unglamorous word, but it really means complex carbohydrate—the healthy,

clean-burning fuel that powers your body.

Finally, fill the remaining half of your plate with vegetables. Ideally, choose two different

varieties—say, a green vegetable like broccoli and an orange vegetable like carrots. These

foods are your nutrition powerhouses. Add fruit for dessert, and you will be set.

You can vary these proportions if you like. As long as your plate is vegan, low fat, and low

GI, you will be fine.

There are a million ways to do this. Some people like an Italian or Mediterranean meal,

which might include bean soup and pasta with a chunky vegetable sauce. Others prefer Latin

American meals, with beans, rice, and vegetables. Some might favor an Asian dinner, with tofu

(which counts as a legume because it is made from soybeans), rice, and vegetables. An Indian-

inspired plate might include a lentil curry with rice and vegetables.

For Americans from Southern states, many traditional foods fit the bill beautifully: beans or

black-eyed peas, rice, and greens (without the traditional fatback).

When my North Dakota parents decided to improve their own way of eating, we substituted

a bean dish and vegetable cutlets for the usual meat dish and added yams or sweet potatoes,

along with a couple of vegetable choices. Dessert was pears, strawberries, or oranges. See the

pattern? It’s still there: a bean dish, a starchy food for healthy carbs, vegetables, and fruit for

dessert.

Simple Snack Ideas

okay, your day’s menu is nearly complete. But even if you feel you will not be

hungry between meals, pencil in a few snack ideas so you will be ready in case

the munchies do hit. A 3:00 p.m. Hunger pang can erode your resolve, so stock

up on things that you can feel good about eating. Here are some snack

suggestions.

Fruits have a surprisingly low GI in most cases, and they are unbeatable for

nutritional value. Keep apples, oranges, pears, bananas, and other fruits on hand.

Some people like to keep a bowl of cantaloupe and melon chunks in the

refrigerator for an instant snack that’s ready when they get home. Don’t forget

tropical favorites, like mangoes and papayas. Dried fruits are acceptable.

Surprisingly, their GIs are not necessarily higher than those of fresh fruit.

Because their water has been removed, however, it is easy to take in far more

calories with dried fruit than with fresh fruit, so it pays to favor the fresh

varieties.

Instant soups are great to keep in your desk drawer; just add hot water when

you are ready to eat. Minestrone, split pea, lentil, and other varieties are typically

vegan and low in fat.

A simple CLT—the sandwich of lettuce and sliced cucumber and tomato

with mustard on rye bread I mentioned above—will fill you up, with nothing to

regret.

Three-bean salad will hold you until dinner.

Air-popped popcorn skips the fat of the usual kind. Top it with garlic salt,

mixed seasonings (e.g., Spike), or nutritional yeast.

Hummus on a whole wheat pita is filling and low in fat if you make it

without added oil.

Other simple snacks include bran cereal with soy milk, pumpernickel or rye

toast with jam, carrot sticks, and rice cakes (look for simple, unsugared

varieties).

STEP 2: A 3-WEEK TEST DRIVE

All right, you are doing great! You have made good choices that will give you a

healthy start. Now, let’s take a 3-week period and, during that time, let’s make it

all vegan all the time. That means no animal products at all, keep the oils low,

and favor healthy, low-GI foods. At this point, that will be easy, because you

picked out the foods you like during week one. No need to whip up something

new every day. It is fine to repeat items, use leftovers, or make your life easy in

any way you can. Remember, though, do not limit calories or skip meals.

It is essential to be realistic. If you do not enjoy cooking now, that is unlikely

to change. Plan to have foods on hand that require little preparation.

Will you be at work? Traveling? Planning ahead is essential. If there is

nothing healthful in the company canteen, you will want to pack a lunch.

Sometimes when a colleague asks what I am having for lunch, I answer, “les

restes d’hier.” This sounds exotic until I explain that the phrase is actually

French for “leftovers.” But the fact is, my leftovers sometimes are exotic,

depending on which restaurant filled the doggie bag!

Let’s Go Shopping

It pays to stock your shelves with the foods and ingredients you will need so

your 3-week test drive goes smoothly. And when hunger hits, you will be ready.

Take a trip down those aisles at the supermarket that you may well have

neglected in the past. The produce department may stock meat substitutes, soy

milk, and other healthy products, along with an ever-growing array of new and

interesting fruits and vegetables. Also check out the “international,” “health,”

and “dietetic” aisles. And look at the shelves with innumerable varieties of rice

and colorful dried beans.

Be sure to check out your nearest health food store if you have not done so

already. You will find substitutes for meat and milk and interesting foods from

other countries, all worth a try. Explore and experiment; some new finds will

become favorites. If the occasional purchase turns out to be a dud, do not worry.

That is what experimenting is all about.

As you shop, pick up ingredients that will allow you to prepare a few extra

things on the weekend—a pot of soup or stew, for example—that you can then

split into portions for quick reheating during the week.

You will notice that prices for healthful foods vary widely. Overall, plant-

based foods are less expensive than meaty or cheesy products. Beans, fresh and

frozen vegetables, pasta, rice—these humble ingredients cost very little.

However, health food stores sometimes put premium prices on prepared

products, which is true for nonvegetarian as well as healthful vegan items. You

will soon sort out your best choices.

While you are at the store, pick up a vitamin B

12

supplement, and if you do

not get regular sunshine, purchase a vitamin D supplement, too.

Some Staples: Basic Foods to Taste and Try

There are a few basic foods that would be good for you to get to know. They are

not elaborate—just simple, basic staples that ought to be on your shelves. If they

are new to you, they will be healthful additions to your repertoire. Let me list

some here and encourage you to think about them when shopping.

Old-fashioned oatmeal. Choose this variety rather than instant, and see how

easy and fast it is to make. Just combine 1 part oatmeal with 2 parts cold water,

bring to a boil, and simmer for a few minutes. That’s all there is to it. Oatmeal is

loaded with soluble fiber to bring your cholesterol down and filling enough to

keep hunger at bay all morning. While you are at the store, pick up some

toppings: cinnamon, raisins or other fruit, or whatever calls to you.

Beans. Get to know the many varieties of this humble food. Very low in fat;

devoid of cholesterol; high in soluble fiber, calcium, and iron; and with an

enviable glycemic index, beans’ day has arrived. Cook them up from scratch if

you like, but it’s handy to stock your shelves with a couple of cans of black

beans (and a jar of salsa), fat-free “refried” beans, and any other varieties you

see.

Frozen vegetables. Convenience is the word here. If you are the slightest bit

pressed for time, you will be glad you have vegetables in your freezer that just

need a little steaming. Nutritionally, frozen vegetables are equivalent to fresh.

Look for broccoli, winter squash, petite Brussels sprouts, carrots, cauliflower,

and anything else you fancy.

Lentil soup. Lentils assert themselves in a hearty and healthful soup. Keep a

can or two on hand.

Hummus. As I mentioned above, this simple chickpea dip has become an

enormously popular sandwich filling. But skip the commercial brands, which are

too high in fat. If you have a food processor, you can make your own in less than

5 minutes, and you will be set for the week.

Chickpeas. Speaking of chickpeas, this is one legume that is really at home

just about anywhere—not just as hummus but also in salads, soups, pasta sauces,

and stir-fries. You can even eat them for breakfast. Keep a few cans on your

shelf; the extra-small cans with pop-top lids are especially convenient.

Toppings. Dijon mustard is great for sandwiches, and lemon juice or apple

cider vinegar is great on green vegetables and salads. Salsa was just made for

beans, and fat-free dressings of any variety are handy, too.

Brown rice. Most people have never tasted a properly prepared bowl of rice.

The trick is to select brown rice, toast it slightly, and cook it like pasta, using

what may seem like too much water and draining away the excess at the end.

Barley. This grain is all over the breakfast cereal aisle, in puffed and sugared

form, but barley really shines in soups or when served as a grain side dish. You

can mix it with rice and cook them together. Barley has a low GI, lots of soluble

fiber, and wonderful taste and texture.

Spaghetti sauce. Take a few minutes to read labels on jars of marinara sauce

to find varieties that exclude cheese and other animal products and keep oil to a

minimum. Then stock your shelves for a quick and easy dinner. Pick up your

favorite pasta to go with it.

Meat substitutes. Try the veggie versions of hot dogs, burgers, and deli

slices. They are not haute cuisine, but they serve a useful purpose, and some

taste surprisingly similar to the foods they imitate. Read the labels, though, and

skip products with animal-derived ingredients or more than 2 to 3 grams of fat

per serving. Health food stores have a huge selection, and many regular

supermarkets carry them, too.

Nutritional yeast. You can find this in the supplement aisle at health food

stores. Nutritional yeast dissolves into spaghetti sauces, stir-fries, casseroles,

soups, and lots of other recipes, adding a subtle cheese-like taste. It is not the

same as brewer’s yeast or baker’s yeast, both of which taste bitter. Nutritional

yeast comes in flakes and powder. For better texture and versatility, buy the

flakes.

Fresh fruit. Fresh fruit is a perfect snack, and you will want to keep it on

hand. Buy extra for friends and family.

Check the Label

There are two things you want to look for on product labels. First, check the ingredients list to

make sure there are no animal-derived ingredients. Common ones include milk solids, whey,

casein (and various casein derivatives, such as sodium caseinate), egg products, and gelatin.

Also be on the lookout for partially hydrogenated vegetable oils, which are as bad as saturated

fat.

Sometimes people want to make exceptions for foods that sound as if they are healthful.

Honey, for example, has gotten unjustified good press over the decades. Nutritionally speaking,

it is simply sugar, offering you nothing from a health standpoint. Rather like olive oil, its

marketing has gotten way ahead of its value.

Next, check the Nutrition Facts. Ideally, a serving of food will have no more than about 3

grams of fat and should have zero cholesterol. If the cholesterol content is anything other than

zero, the product contains some animal-derived ingredient. If label reading seems a bit

cumbersome, keep in mind that you need to check a product only once. As you find the

products that fit the bill, there’s no need to check them again. Also, simple foods do not need

labels. No one ever had to look for the fine print on a banana or pear, a box of frozen spinach,

or a bag of navy beans. Each of these foods has exactly one ingredient.

What to Do with Unhealthy Foods?

So you have filled your shelves and refrigerator with healthy staples. If some

not-so-healthful items from your previous diet are still lurking, though, what do

you do? That’s easy: get rid of them. Do not “use them up” because they will

continue to cause problems for you. Toss them. And if family members or

roommates share your kitchen space, avoid keeping tempting foods too near

your own. They will present more of a temptation than you need.

Planning Ahead

Eventually, healthful eating will become second nature. For now, though, you

will need to put a bit of thought into where you will be at lunchtime and

dinnertime and what you will have. There really are healthy choices out there,

but they are sometimes not so obvious in a culture that caters to unhealthy tastes.

It helps to plan ahead.

ON YOUR MARK, GET SET…

As we’ve discussed, you will want to pick out a 3-week period and really dive

into this new menu. Choose a time when you have the mental energy to embrace

a change. If you are an accountant, April 14 probably is not a good time. If you

are a student, exam week may not be the best choice. But once you have picked

your time, jump in with both feet. Do the diet change 100 percent. Follow our

three guidelines as closely as humanly possible, and do it all the way.

Okay, you have done great. You have the basics down. In the next several

chapters, we will look at specific health issues and situations you may encounter,

and I will offer plenty of tips for handling them.

CHAPTER 6

Healthful Weight Control

If you have been aiming to lose weight, let me show you the steps that make the

process as easy, effective, and permanent as possible. Eliminating unwanted

pounds is important for anyone—but especially for people with diabetes. For

starters, it boosts your insulin sensitivity; the more body fat you trim away, the

more responsive your cells are to whatever insulin your pancreas is producing.

Weight loss also brings down your cholesterol and blood pressure. And when

you’ve trimmed away body fat, exercise is that much easier and more inviting.

Your joints—especially your knees—will thank you.

Needless to say, there are a great many ways to lose weight. Cutting calories

works for some people, but others find it a real challenge. If you normally eat

2,000 calories per day, for example, a common recommendation would limit you

to 1,500—and that gets old very fast. If you’re hungry at 8:00 in the evening and

you’ve already had your 1,500 calories for the day, you will go to bed hungry.

That will never happen on the program recommended in this book.

A healthy approach to weight loss focuses on choosing the right kinds of

foods, not on the quantity of food you eat. When you have the right foods on

your side, the calories and portions fall into line on their own, and weight loss is

almost automatic.

A WEIGHT-LOSS DIET THAT WORKS

In 2005, my research team published the results of an important study that tested

a new and powerful approach to weight loss. The participants were women with

moderate to severe weight problems. Most had tried many different diets: low-

calorie diets, low-carb diets, Weight Watchers, the cabbage-soup diet, and just

about everything else. Like most people, they had found these diets tough to

follow, and whatever weight they lost soon returned.

Our approach was very different. It did not include calorie counting, limits

on portions or carbohydrates, or even an exercise prescription. For research

purposes, we wanted to isolate the effects of diet.

The participants lost weight easily, averaging about 1 pound per week—

week after week after week—and they kept it off long-term.

1

Other researchers

have found much the same thing.

Why is a plant-based diet so powerful for weight control? Well, first of all, it

is important to understand where the calories are hiding in the foods you eat. A

chicken stores extra calories in chicken fat. A cow stores calories in beef fat. A

fish stores them in fish fat. Body fat—in humans or animals—is a calorie-

storage system.

If you were to remove a bit of fat from a drumstick or chicken wing and send

it to a laboratory, you would find that a gram of fat—that’s

1

⁄

28

ounce—has 9

calories. That is a lot. It is more than double the calories in a gram of

carbohydrate—the starch in rice, beans, or sweet potatoes, for example.

Carbohydrates have only 4 calories per gram. Small wonder that people who

make rice or other plant foods their staples tend to stay slim. Throughout Asia

and rural Africa, rice and other grains, root vegetables, and various legumes are

the traditional foundation of the diet. These foods are filling but have relatively

few calories.

Of course, it’s a different story in North America and Europe, where meals

feature meat and dairy products, which contain the very fat that animals have

used to store their excess calories. Weight problems are the all-too-common

result. If you want to avoid taking in extra calories, you would do well to avoid

eating the concentrated calories that animals have hidden away in their body fat.

So, step one is to avoid animal products. If you do that, you will of course

avoid animal fat completely.

Step two is to keep vegetable oils to a minimum. Beans, grains, vegetables,

fruits, and most other foods from plants have very little fat. There are a few

exceptions, however: nuts, seeds, avocados, and some soy products are high in

fat. Keep them to a minimum as well.

Be especially careful about vegetable oils used in cooking or in salad

dressings. Now, some people argue that plant oils are more healthful than animal

fats, and it’s true that they are much lower in saturated fat, the kind that raises

cholesterol levels and is linked to breast cancer and insulin resistance. When it

comes to weight problems, however, animal fats and vegetable oils are

essentially all the same. They all pack in 9 calories per gram.

Step three is to focus on high-fiber foods. A grain of brown rice, for

example, has a thin cloak of fiber that gives the rice its tan color. To produce

white rice, manufacturers strip away this coating, but you are better off if it is

left intact. Fiber fills you up so you feel naturally satisfied with fewer calories.

As you saw in Chapter 4, every 14 grams of fiber added to your daily menu

cuts calorie intake by about 10 percent on average.

2

That simply means that

high-fiber foods fill you up faster, so you stop eating sooner. Instead of trying by

sheer force of willpower to cut calories, you cut them without even thinking

about it.

The richest sources of fiber are beans, vegetables, fruits, and whole grains.

While breakfast cereal commercials tend to push grains as the best fiber source,

you will find much more fiber in beans and most vegetables than in most grains.

But they all add up. Aim for at least 40 grams per day. One caveat: If high-fiber

foods, especially beans, have not been part of your routine, you’ll want to

increase the amount you eat gradually to give your digestive tract time to adjust.

See Chapter 9 for more tips on avoiding digestive problems.

In the next chapter, I will show you an easy way to check your fiber intake

using the Quick Fiber Check.

Okay, let’s summarize: To lose weight, you want to avoid animal products,

limit the use of vegetable oils, and go high fiber. Vegetables, fruits, whole grains,

and beans fit the bill perfectly.

Steps to Weight Loss

1. Avoid animal products. If you steer clear of fish, chicken, beef, dairy foods, and all other

animal products, you will cut your animal fat intake to zero. What’s more, this shift will mean

that you will naturally eat high-fiber foods to replace those from animal sources, which have

no fiber.

2. Keep vegetable oils to a minimum. If you have a bottle of cooking oil in your kitchen, throw it

away. There are simpler and better ways to cook. Also limit nuts, seeds, avocados, and full-

fat soy products.

3. Favor high-fiber foods. Build your meals from beans and other legumes, vegetables, fruits,

and whole grains.

To ensure complete nutrition, be sure to have a vitamin B

12

supplement each day.

HEALTHY EXAMPLES

By now, you already have a good idea of what this looks like on your plate,

because the diet changes for weight loss are very much like those for controlling

your blood sugar. Breakfast might start with veggie sausage or veggie bacon—

that is, faux meats made of soy or wheat—followed by a big bowl of oatmeal or

perhaps some fresh fruit. You would skip bacon, eggs, and ordinary bagels,

which are stripped of fiber.

Lunch could be a sandwich made with sliced tomato, lettuce, and veggie deli

slices on rye, or a pasta salad would be fine, too.

For dinner, you might try tomato or split pea soup followed by a vegetable

stir-fry or shepherd’s pie filled with chunky vegetables. In the process, you will

avoid animal fat, have very little vegetable oil, and get all the fiber in those

healthy vegetables.

For a between-meal snack, an apple or banana fits the bill nicely, while

potato chips or nuts pack too much fat.

Vance

When Vance joined our study, he wanted to get his weight down to 210 to 225

pounds. Since he initially weighed in at 276 pounds, he had a ways to go. He

stuck to the diet program, however, not worrying about calories or portions but

paying close attention to the types of food he chose. Everything was vegan and

low in fat. Also, in order to give the diet a good test, he agreed not to add any

exercise for the first 6 months.

The pounds started to come off. Three months later, he weighed in at 251—a

loss of 25 pounds in about 12 weeks. Friends couldn’t help but notice, and many

asked him what his secret was. After 6 months, he was down to 238. At the 14-

month mark, he was at 217.

Nancy

Nancy began the study at 197 pounds. Like Vance, she changed her diet but kept

her activity level the same to allow us to test what the diet change alone could

do. Three months into the program, her weight was down by 14 pounds. After 6

months, she had lost 25 pounds, and at 14 months, she weighed 155 pounds—a

loss of 42 pounds without counting calories.

Not Exactly Health Food

A few years ago, I was running a study on diet and weight loss and found that a couple of our

participants were chowing down on Twizzlers—the red candy that comes in long twists like

licorice. When I asked why they were eating candy, they pointed out that the product is both

vegan and low in fat. And sure enough, there’s a friendly message printed on a package of

Twizzlers Strawberry Twists:

Did you know…

Strawberry Twists are a low-fat candy! That’s right, the same great-tasting

Twizzlers you have known and loved are low in fat, as always. Nothing has changed.

A look at the ingredients list shows that, indeed, nothing has changed. Like other candies, it

is basically a sugary concoction containing nothing that your body even remotely needs. Sugar

is nowhere near as high in calories as fat, but it still provides more calories than you need.

FOODS THAT WORK MAGIC

These simple foods have surprising effects. Not only do they help you trim

hundreds of calories off your daily menu, they also cause a fundamental change

within the cells of your body. As you saw in Chapter 2, clinical tests have shown

that they increase your body’s after-meal calorie burn. The reason is this: As you

change your diet, your insulin sensitivity begins to improve. That means that

glucose has an easier time entering your cells to be burned for energy, rather than

continuing to circulate in your blood.

3

The after-meal calorie burn is small, but it

lasts for 3 or more hours after each meal, giving you an extra edge for losing

weight.

APPETITE CONTROL

Barbara Rolls, PhD, a researcher at Pennsylvania State University, has proposed

an innovative way of thinking about appetite control based on a concept called

energy density.

4

Her studies have looked at what triggers satiety—the sense of

fullness after meals—and shown how to plan meals to bring on a feeling of

satiety earlier.

Surprisingly, what makes us stop eating does not seem to be the number of

calories we have ingested, nor is it the amount of carbohydrate or protein in a

meal. Rather, it is the weight of food we have taken in. It is as if your stomach

has a scale, and once it registers a certain number of grams of food, it signals

your brain that you have had enough.

We all tend to eat roughly the same weight of food each day. If your meals

do not add up as they normally do, your appetite guides you to have a little more.

There’s an effective weight-loss strategy in there. If the foods you eat contain

a fair amount of water—soups or fruit, for example—they are heavy enough to

tip your “stomach scale” and reduce your appetite. Because the weight of these

foods comes mainly from water, which has no calories, they tend to cut your

total calorie intake for the day. These foods have a low energy density. That is,

they have relatively few calories, even though they might have enough weight to

convince your stomach that you’ve eaten quite a lot.

One important caveat: For some reason, simply drinking water will not turn

off your appetite. Your stomach apparently reacts differently to heavy foods—

which trigger an appetite shutoff—than to a drink of water, which does not.

Dr. Rolls proved this with an interesting lunchtime experiment. When

research volunteers ate a casserole appetizer along with a glass of water, they ate

about 400 calories at lunch. In a separate test, however, she stirred the glassful of

water into the casserole to make soup. When she measured the participants’

calorie intake afterward, she found it was cut to less than 300. The soup tricked

their stomachs into shutting off their appetites.

Here are some tips for reducing the energy density of your meals.

• Soups are a great choice. They are filling but generally low in calories. Favor

clear, low-sodium soups rather than creamy varieties.

• Add tomatoes, chickpeas, cucumbers, peppers, and other vegetables to turn a

salad into a meal while keeping it low in calories. Use fat-free dressing,

lemon juice, or apple cider vinegar rather than regular oily dressings.

• Apples, oranges, pears, mangoes, papayas, berries, and most other fruits are

excellent choices for snacks, desserts, or a meal.

• Vegetables of virtually any variety are good choices. Adding chunky

vegetables to salads and casseroles reduces their energy density in a very

helpful way.

• Bean dishes are filling, but surprisingly modest in calories if they are made

without added fat. Think of chili and casseroles.

• Go for whole grains. Rice beats rice cakes. Pasta beats bread. In each case,

one is water-based and filling, while the other is airy and not filling at all.

Old-fashioned oatmeal is a great breakfast choice.

Including these foods generously in your menu will accelerate your weight

loss. There’s an easy way to check the energy density of commercial food

products: Just take a look at the label. If one serving has fewer calories than

grams, it is a good choice. For example, the label on a can of black beans

(below) shows that a serving has 90 calories and weighs 122 grams, so the beans

are a good choice.

Black Beans

Nutrition Facts

Serving Size ½ cup (122 g)

Servings Per Container Approx 3½

Amount Per Serving: Calories 90, Calories from Fat 5

A can of spinach has 30 calories and 115 grams per serving, so it’s also a

winner. Each of these foods has less than 1 calorie per gram, so the weight of the

food fills you up before the calories fill you out.

What about skinless chicken breast? One serving has 173 calories and

weighs about 100 grams (3.5 ounces). Not a good choice. Aside from not being

vegan or particularly low in fat (23 percent of calories), it has far more calories

than grams.

A slice of bread may have 80 calories and weigh 32 grams. It has few

calories but is very lightweight, so it is not filling. With more calories than

grams, it is not especially helpful for weight loss.

I am not suggesting that you use energy density in place of the other diet

guidelines in this book. Use it in addition to this program to ramp up the weight-

loss power of your new menu. It will help you pick from among the allowed

foods those that are the most filling with the fewest calories.

Again, the idea is simply to reduce the energy density of the foods you eat by

choosing those that naturally contain a fair amount of water to fill you up and

shut off your appetite.

STEER CLEAR OF LOW-CARB DIETS

Low-carbohydrate diets are popular, on and off. But they are potential disasters

for anyone, especially for people with diabetes. They often bring short-term

weight loss, but most of the weight quickly returns. Low-carb diets also have

wildly unpredictable health effects. In research studies, as many as one-third of

low-carb dieters have shown a significant increase in LDL (“bad”) cholesterol.

Some have had such high cholesterol levels that they have been forced to drop

out of studies.

What’s more, low-carb diets are usually high in protein. The animal protein

that is commonly emphasized in these diets can be hard on your kidneys.

Harvard researchers tracked kidney function in 1,624 women participating in the

Nurses’ Health Study, focusing especially on those who had any loss of kidney

function at the start of the study. It turned out that the more animal protein the

women consumed, the more kidney function they lost.

8

Given that about 40

percent of people with diabetes have already lost some kidney function, it makes

good sense to protect yourself against further damage.

9

I strongly caution against

any diets that recommend high-protein foods.

As you have seen, such diets are based on the outdated idea that avoiding

carbohydrates is the key to glucose control. As you know by now, populations

that make rice, noodles, and other carbohydrate-rich foods their diet staples

actually have had very little obesity and very little diabetes.

Sometimes, when people blame “carbs” for their weight problems, they are

thinking of cookies and cupcakes. But if you have ever looked at recipes for

these products, you know that an enormous load of fat—typically from butter or

shortening—is usually lurking inside. So the carbohydrate in these products is

really an innocent bystander; it’s their load of fat that can fatten you up.

If you are stuck in the “carbs are fattening” mentality, let me share the results

of an important study. National Institutes of Health researchers asked 19

overweight volunteers to follow a rigorously controlled low-carb diet and a low-

fat diet at separate times—all the while under the watchful eyes of the NIH

Metabolic Clinical Research Unit, where they lived throughout the experiment.

Both diets had precisely the same number of calories; the difference was simply

that one was low in fat and the other was low-carb. But the results were clear.

The low-fat diet trimmed away roughly twice as much body fat, compared with

the low-carb diet.

10

Low-carb diets can cause weight loss over the short run, but there are far

healthier ways to achieve that goal and to make weight loss last over the long

run.

Low-Carb Diets Can Worsen Cholesterol Levels

Weight loss lowers cholesterol levels. On average, each pound you lose lowers your

cholesterol level about 1 point (that is, 1 mg/dl or 0.3 mmol/l),

5

so most weight-loss diets have

a side benefit of improving your cholesterol test results. The exception is low-carbohydrate

diets. They are so high in fat and cholesterol that they increase cholesterol levels for about one

in every three dieters, some of whom have eventually experienced wildly high cholesterol levels

and serious heart disease symptoms.

6,

7

There is no good reason to begin any low-

carbohydrate, high-protein diet.

WHAT TO EXPECT

Everyone loses weight at his or her own pace. In our studies using low-fat vegan

diets, weight loss averages about 1 pound per week. Adding exercise can

increase your weight loss depending on your regimen.

You may find that you lose weight, then reach a plateau and stay there for a

while. If that happens, see if there is something in your diet you can change,

such as eliminating hidden sources of oil or boosting your fiber intake, or

bringing in the low-energy-density foods we discussed above. Our bodies seem

to have different plateaus depending on the fat content of our foods. That is to

say, if you drop the fat content slightly, your weight will probably drop a bit,

then plateau. If you drop the fat content more, you’ll drop down to a new

plateau.

The same thing works with fiber. Do a Quick Fiber Check, and if you’re not

up to 40 grams per day, try adding more beans, vegetables, fruits, and whole

grains to your diet. You’ll find that the combination of steering clear of fats and

bringing in fiber helps trim away the pounds.

Take Your Time

If you have gradually gained weight over the years, let it come off gradually.

Don’t starve yourself in the hope of instant results. If you are on an optimal diet

and are physically active, nature will take its course. As the weeks go by, you

will not only be slimmer, you will also be healthier. Your cholesterol and blood

pressure are likely to fall along with your blood glucose. As always, stay in close

touch with your doctor so your medication doses can be revised as you regain

your health.

CHAPTER 7

How to Test Yourself and Track Your

Progress

In this chapter, we will look at the various tests that allow you to track your

progress. The first one, glucose testing, is particularly important, but please read

through the whole chapter. It will help you stay on the right path. We will start

with blood tests and then look at other kinds of testing, including weight, blood

pressure, and examinations of the eyes and feet.

GLUCOSE TESTING

Monitoring your blood sugar is important for controlling diabetes. Glucose is

measured in milligrams per deciliter (mg/dl) in the United States and in

millimoles per liter (mmol/l) in most of the rest of the world.

If you have type 1 diabetes or are using insulin for type 2 or gestational

diabetes, you should check your glucose at least three times a day or according

to whatever schedule your doctor recommends. If you have type 2 diabetes and

are using oral medications, there is no optimal testing frequency. As a rule of

thumb, however, when your diet, medications, exercise routine, or health status

changes, it is important to test more frequently. If your doctor is not yet aware

that you are about to make a change, now is the time to share that information.

You should also discuss what to do if your blood glucose is too high or too low.

As you begin a healthful diet, your numbers are likely to fall significantly.

Regular glucose testing is especially important if you are taking diabetes

medications, particularly insulin or medications that cause your body to release

insulin. The reason is that these are powerful drugs that actively push your blood

sugar down. And you are now starting a powerful new diet. The combination of

these treatments—drugs and diet (sometimes along with exercise)—may end up

pushing your blood sugar too low.

I know what you may be thinking: Impossible! If all you have ever heard

from your doctor is that your blood sugar is too high, it’s hard to imagine it

could fall too low. Well, it can. The combination of a powerful diet and the

diabetes medications you may already be on can be very strong. In fact, your

blood glucose can fall so low that you start to shake and sweat (see below for

other symptoms). This is called hypoglycemia. In rare cases, people who make a

major diet change or embrace a strenuous exercise program without backing off

on medications find their blood sugar drops dangerously low—so low that they

can lose consciousness. This is why it is essential that your doctor be made

aware of the changes you are making—so your medication dosages can be

altered if your blood glucose takes a nosedive.

Dangerous hypoglycemia is very unlikely if you are on no medications, and

it is also unlikely if you are being treated with only metformin (Glucophage) or a

thiazolidinedione, such as pioglitazone (Actos) or rosiglitazone (Avandia).

However, hypoglycemia is likely to occur if you take any of the following drugs.

• Insulin (injected or pump)

• Glyburide (Micronase, Glynase, DiaBeta, or the combination drug

Glucovance)

• Glipizide (Glucotrol)

• Glimepiride (Amaryl)

• Nateglinide (Starlix)

• Repaglinide (Prandin)

This is just a short list of medications that may put you at risk. Ask your

doctor if the medications you are taking may cause hypoglycemia.

Although hypoglycemia is a sign that your body is regaining its insulin

sensitivity—which is of course a good thing—it is also a sign that your

medicines are now too strong and that you need to speak with your physician

right away about adjusting your medication regimen. If your doctor has stopped

your medications, hypoglycemia is very unlikely to occur.

Symptoms of hypoglycemia include:

• Shaking

• Sweating

• Hunger

• Anxiety

• Weakness

• Rapid heartbeat

• Dizziness or lightheadedness

• Sleepiness or confusion

• Difficulty speaking

If you experience these symptoms, check your blood sugar. If it is below 70

mg/dl (3.9 mmol/l) or whatever other benchmark value your doctor

recommends, you need to eat something that raises your blood sugar quickly. If

you notice symptoms while driving, pull over to a safe spot. And if you are

unable to test your blood sugar or are unsure whether it is low, assume that it is

low and have something to eat. Glucose tablets are a great choice. They are sold

at all drugstores, and you will want to keep them in your purse or briefcase and

in your glove compartment. If your blood sugar check shows you are

hypoglycemic, you should take 15 grams of glucose. If you have typical glucose

tablets with 4 grams of glucose each, you will need to take four tablets at once.

Here are some other good choices.

• ½ cup (4 ounces) of any fruit juice

• ½ cup (4 ounces) of a regular (not diet) soft drink

• 5 or 6 pieces of hard candy

• 1 or 2 teaspoons of sugar

After 15 minutes, check your glucose again. If it is still below 70 mg/dl (3.9

mmol/l), have another serving, then check again in another 15 minutes. If you

are within an hour of mealtime, go ahead and eat. If not, have a snack. Be sure to

carry glucose tablets or a quick-energy food with you for emergencies, wear a

medical identification bracelet, and be especially attentive to your glucose level

during exercise, which can cause blood sugar to drop.

Hypoglycemia can also occur while you are asleep. Look for these signs.

• Nightmares or crying out

• Finding that your pajamas or sheets are damp from perspiration

• Awakening with unusual tiredness, confusion, or irritability

Carl’s Hypoglycemic Episode

Carl had been taking metformin and glipizide for about 5 years, and his morning blood glucose

values ranged between 120 and 150 mg/dl (6.7 and 8.3 mmol/l). He changed his diet with the

hope of coming off his medications, and in fact, very soon after he began this program, his

readings began to drop. After about 2 weeks, they were often under 100 mg/dl (5.6 mmol/l).

Carl was delighted with such clear evidence that the changes were working.

About a month into the diet, he had an unusual experience. One morning at about 10:00

a.m., he found himself feeling unusually hungry. He always had a good appetite, but this was

something different. He felt ravenous. Over the next several minutes, he started to tremble and

broke into a sweat. “Oh, yes,” he thought to himself. “This is what they told me might happen.”

He checked his blood glucose, and it was 65 mg/dl (3.6 mmol/l), which is lower than it should

be. He had some orange juice and an early lunch. He telephoned his doctor, who reduced his

glipizide dosage. Over the next several weeks, the episodes repeated several times.

Eventually, his doctor stopped the glipizide altogether.

Carl’s morning blood glucose readings stabilized at around 80 to 90 mg/dl (4.4 to 5.0

mmol/l). He never needed to go back on glipizide, and he never had another hypoglycemic

episode.

If these occur, you can check for nighttime hypoglycemia. Simply set your

alarm for about 2:00 or 3:00 a.m. and check your blood sugar a few nights in a

row. Consult your doctor to see if you need a medication change.

Hypoglycemia does not mean there is anything wrong with your diet. Rather,

it means that the medication regimen you are on has become too strong for you.

The next step is to contact your physician or other caregiver, who will probably

reduce your medication dosages or eliminate one or more drugs. Get in touch

with your doctor as soon as possible—the same day the episode occurs. Do not

put it off, because the hypoglycemic episodes are likely to recur until your

medications are reduced.

To track your blood sugar, use a logbook or a simple grid like the one below.

Blood Glucose

DATE MEDICATION REGIMEN EARLY BREAKFAST LUNCH DINNER LATE

/ / /

Note: It is especially helpful to check your blood glucose before meals. Mark these numbers to

the left of the slash marks. Mark after-meal values to the right of the slash marks.

MAKING SENSE OF GLUCOSE

Blood glucose values are a bit like the stock market: Although they generally

follow a trend, they can bounce around from day to day. Certain situations can

trigger an unexpected rise. Any sort of illness or infection can boost your blood

glucose; even a minor upper respiratory illness or a scraped foot can cause a

significant jump in your numbers. Stress can, too, due to the action of stress-

related hormones.

Having some up-and-down swings in blood sugar is normal, but if your

glucose remains high day after day, your risk of complications is higher than it

would be if your glucose level were better controlled. The American Diabetes

Association recommends that people with diabetes use the following guidelines

for blood glucose levels.

• Fasting or before meals: 80 to 130 mg/dl (4.4 to 7.2 mmol/l)

• One to 2 hours after a meal: below 180 mg/dl (10.0 mmol/l)

THE DAWN PHENOMENON AND THE SOMOGYI EFFECT

You may occasionally be surprised to find that your blood glucose is higher in

the morning than it was when you went to bed the night before. Or perhaps you

checked your glucose in the early morning and then went back to sleep, only to

find that it had risen while you slept. How is this possible?

No, sugarplums dancing in your head had nothing to do with it. The fact is,

your body constantly monitors the amount of glucose in your bloodstream and

adjusts it from time to time. Glucose is vital to your body’s functioning—

especially to the workings of your brain—so your body has a way of increasing

your blood glucose when it gets a bit low. In the early-morning hours—typically

between 5:00 and 9:00 a.m.—hormones (growth hormone, cortisol, and

catecholamines) cause your liver to release glucose into the bloodstream. These

hormones can also interfere with insulin’s efforts to remove glucose from the

blood. This “dawn phenomenon” can noticeably raise your blood sugar.

1

A similar reaction can occur when a person using long-acting insulin has an

unusual blood glucose dip in the middle of the night. Let’s say, for example, that

you miss your usual late-night snack, and the insulin you are taking forces your

glucose level too low. Once again, your natural hormones will compensate,

raising your blood sugar. This is called the Somogyi effect. It is different from

the dawn phenomenon in that it is triggered by an overly low blood sugar level

occurring in the middle of the night.

Although your body has a system for controlling your blood sugar, it is a bit

imprecise. Your blood sugar can still run too low or too high despite your body’s

best efforts, and you will occasionally see a high or low level that you cannot

explain.

HEMOGLOBIN A1C

As discussed in Chapter 1, the main test for assessing your progress is

hemoglobin A1C. Your A1C level should be checked every 6 months, or every 3

months if your diet, medications, or general health is changing or if previous

values have been too high. If your A1C is high, your doctor will be concerned,

and you should be, too. If it is low, you are doing well. To give you a frame of

reference, the American Diabetes Association says that most people with

diabetes should keep their A1C below 7 percent. A lower target, say 6.5 percent,

makes sense if you can get there without risking hypoglycemia (that is, if you

are not on medications that are likely to cause hypoglycemia). If you do tend to

have frequent hypoglycemic episodes, your caregiver may recommend a less

stringent target, say 8.0 percent, in order to keep your blood glucose from falling

too low.

A typical oral diabetes medication brings A1C down by an average of about

1 point or a bit less. The effect of a good diet on A1C varies depending on how

good your control is when you start, how well you follow the diet, and how

much excess weight you lose. Your result will also be affected by exercise,

genetics, and other factors.

The biggest drops we have seen in short-term research studies are around 4

points in approximately 6 months. These are seen in people whose A1Cs were

high (say, 9 or 10) to begin with. People whose A1Cs are in the 7 to 8 range are

likely to have a drop averaging between 1 and 2 points. People who continue to

lose weight beyond this time could have an even greater drop, assuming they

were not already in the normal range.

The higher your A1C, the greater your risk of circulatory problems.

Evidence suggests that keeping A1C low is particularly important for the health

of your eyes and kidneys and for preventing nerve symptoms.

From your heart’s standpoint, a 1-point increase on the A1C scale—from 7

to 8 or 8 to 9, for example—brings about a 20 percent increase in your risk of

heart problems over about a decade.

2

In other words, if you had a 10 percent risk

of having a heart attack sometime in the next decade, a 1-point rise in your A1C,

maintained over the whole decade, would boost your risk to 12 percent. A 2-

point rise would mean a 14 percent risk, and so on. What these numbers tell us is

that A1C is important and that by all means, you will want to aim to get your

A1C down. However, A1C is not the sole key to good health. To stop diabetes

from attacking your heart and blood vessels, you will also want to focus on your

blood pressure, cholesterol, and weight. Needless to say, your doctor can and

should track these values with you.

CHOLESTEROL

Your doctor will check your cholesterol at regular intervals, at least once a year.

As you will see in Chapter 12, high levels of cholesterol in the blood can damage

your heart, major blood vessels, and the delicate blood vessels of the eyes and

kidneys. Here are the numbers to aim for.

3

Total cholesterol. According to most authorities, total cholesterol should be

below 200 mg/dl (5.2 mmol/l). I suggest you aim for a considerably lower goal,

however. First of all, the average cholesterol level in the United States is

hovering around 200 mg/dl, and in a country where heart attacks are the cause of

death for half the population, you do not want to be anywhere near average! In

large population studies, it is clear that the lower your cholesterol, the lower your

risk of heart problems, until you reach a threshold of about 150 mg/dl (3.9

mmol/l). My suggestion is to use that as your goal rather than the more

permissive “official” figure.

Low-density lipoprotein (LDL) cholesterol. LDL cholesterol is often called

bad cholesterol because it raises your risk of heart problems and other blood

vessel complications. According to most authorities, your LDL should be below

100 mg/dl (2.6 mmol/l). Your risk of heart problems drops as LDL decreases,

until you reach a level of approximately 40 mg/dl (1.0 mmol/l).

4

High-density lipoprotein (HDL) cholesterol. HDL cholesterol is often

called good cholesterol because it carries cholesterol out of the body. Some

evidence suggests that the higher your HDL cholesterol, the better. Current goals

are to have an HDL level above 40 mg/dl (1.0 mmol/l) for men and above 50

mg/dl (1.34 mmol/l) for women.

Some doctors, however, interpret HDL in the context of your total

cholesterol concentration: In this case, a favorable HDL reading would be at

least one-third of your total cholesterol. For example, if your total cholesterol is

150, a healthy HDL would be 50 or above. This is an important consideration

because many people who follow healthful diets do not have much of any kind

of cholesterol—LDL, HDL, or anything else.

Recent evidence has called the importance of HDL into question. Although

lowering LDL cholesterol does reduce your risk of heart problems, raising HDL

does not seem to make any difference.

Triglycerides. Triglycerides are tiny fat particles transported in the

bloodstream. Normal triglyceride concentration is less than 150 mg/dl (1.7

mmol/l).

See Chapter 12 for information on controlling cholesterol and triglycerides.

TRACKING YOUR BLOOD PRESSURE

Maintaining healthy blood pressure is extremely important. As you can imagine,

increased pressure inside your arteries can damage the arteries themselves, as

well as your heart, eyes, kidneys, and nerves. The longer your blood pressure

stays high, the more damage it can do.

Problems can travel in the other direction, too: Damage to the kidneys can

lead to high blood pressure. The reason is that your kidneys play an important

role in regulating your blood pressure, and if they have been assaulted by

diabetes, they can lose some of their ability to do this.

In Chapter 12, we will look at how diet affects blood pressure. For now, here

are your targets.

Normal blood pressure is less than 120/80 millimeters of mercury (mmHg).

If you have high blood pressure, your caregiver will work with you to reduce it

to below 140/90, and to below 130/80 if you can get there without serious

medication side effects. If you are pregnant, the target will be 120–160/80–105,

aiming to protect both you and your baby.

5

It goes without saying that diet changes are key for controlling blood

pressure and can often make medications unnecessary. The same plant-based diet

that helps you lose weight and brings down your blood sugar will also help you

control your blood pressure.

Have your blood pressure checked regularly. If it is not where it should be,

take another look at your diet and speak with your doctor about what, if any,

additional treatments you may need. A healthful diet and the weight loss it brings

can also mean that your caregiver will cut back on blood pressure medicines you

may be on, or stop them altogether. But don’t stop your medicines on your own.

CHECKING YOUR KIDNEY HEALTH

Because your kidneys can easily be affected by diabetes, your doctor will check

your kidney health with a simple urine test at least once a year. The goal is to see

whether your kidneys are losing protein, specifically a protein molecule called

albumin. Albumin itself is not especially important. What is important is that if it

shows up in your urine, it is a sign that your kidneys have been affected by

diabetes and are not holding on to albumin as they should. Albumin losses of

greater than 30 milligrams over 24 hours are considered abnormal. Your doctor

will also check your blood for creatinine and estimate your glomerular filtration

rate and will interpret the results of these tests for you. For more on factors that

influence kidney health, see Chapter 13.

OTHER ROUTINE LABORATORY TESTS

Your doctor will run other tests to track your progress. The following are two

very common ones.

Complete blood count (CBC). This test shows the state of your blood cells.

Many people with diabetes develop anemia, meaning they have fewer red blood

cells than they should. A complete blood count lets your doctor easily check this

and many other measures. If your blood count is low, your doctor will

investigate the reasons for it, which could include kidney disease, iron

deficiency, use of certain medications, abnormal bleeding, or other factors.

Chemistry panel. A routine chemistry panel is also known by several other

names. It assesses your overall health, with a special focus on the status of your

kidneys and liver and lets doctors check for potential adverse effects from

medications.

There is no reason to despair if any of your laboratory values are not where

they should be, but it is definitely a reason to take action. You will want to

optimize your diet and work with your doctor to plot a course for tracking the

effectiveness of your overall health regimen.

TAKING STOCK OF YOUR DIET

I would like to shift gears now and look at your diet and overall health. First,

let’s take a minute to make sure that your diet is going according to plan.

• Are your foods vegan? You know you are doing well if there are no foods of

animal origin on your plate, not even little bits of fish, fat-free milk, or egg

white—nothing. If you have done this right, there is no animal fat, no

cholesterol, and no animal protein in your diet. Your menu is built from plant

foods, and it is rich in fiber and all the healthy nutrients the plant kingdom

brings you. If you need a refresher on why you are doing this, please take

another look at Chapter 4.

• Are your meals all low in fat? It is important to really keep fats and oils to an

absolute minimum. Be careful with nuts and nut products.

• Are your foods low GI? The main problem foods are sugar, corn syrup (a

common sweetener in processed foods), white and whole wheat breads

(favor rye and pumpernickel), and baking potatoes (choose sweet potatoes

and yams).

QUICK FIBER CHECK

One way to help gauge how you are doing is with the Quick Fiber Check. It is a

handy little tool, and I suggest that you do one about once a week as you begin

this new approach to eating. Scoring is simple and takes only a minute or two to

learn. Soon, estimating the fiber content of virtually everything in the

supermarket will be a snap. You will also see if you are getting enough fiber in

your daily menu. It does not take long, and it will help you see if you are on

track.

First, take a minute to jot down everything you ate or drank for 1 full day on

a form similar to the example below. I will explain below how to fill in the fiber

column.

Then, next to each food, note its fiber score, using the following guide.

Beans: For each serving of beans or lentils (one serving = ½ cup) or any

food that includes about this amount of beans or lentils as an ingredient, give

yourself a 7. One cup of soy milk or ½ cup of tofu (both made from soybeans)

rates a 3.

Vegetables: For each serving of vegetables (one serving = 1 cup), give

yourself a 4. An exception is lettuce, for which 1 cup scores a 2. A potato with

skin scores a 4; without the skin, a 2.

Fruit: For each medium piece of fruit (e.g., an apple, orange, or banana; 1

cup applesauce; a banana smoothie), mark a 3. For 1 cup of juice, mark a 1.

Grains: For each piece of white bread, bagel, or equivalent, score a 1.

Whole grain breads score a 2, as does 1 cup of cooked pasta. One cup of rice

scores a 1 for white and a 3 for brown. One cup of cooked oatmeal scores a 4.

Score a 3 for typical ready-to-eat cereals, a 1 for highly processed and colored

cereals, and an 8 for bran.

Soda, water: Score a 0.

Interpreting Your Score

Total your fiber score and let’s see how you are doing.

Less than 20: You need more fiber in your diet. As it is, your appetite will

be hard to control, and you may have occasional constipation. Boosting fiber

will help tame your appetite and cut your risk of many health problems.

20–39: You are doing better than most people in Western countries, but as

you bring more fiber into your diet, you will find that it makes foods more

satisfying and cuts your calorie intake a bit.

40 or more: Congratulations! You have plenty of healthy fiber in your diet to

control your appetite and help keep you healthy. Fiber also reduces your risk of

developing cancer, heart disease, diabetes, and digestive problems.

CHECKING YOUR WEIGHT

Of all the things that predict success in dealing with diabetes, leaving behind

excess weight is among the most important. The strategy outlined in Chapter 6 is

a highly effective way to go about it.

Here are some tips for tracking your progress.

• First, track your weight. Some people who have been overweight for a long

time have not gone near a scale in years. If that sounds like you, give it

another try. It is essential to know if you are losing. If you are not losing

weight, it is time to change course. Usually, that means tuning up your diet.

Weight loss is sometimes difficult, and genetic tendencies do play a role, but

your diet is one thing you really can control.

• Use the same scale each time you weigh yourself. Different scales can give

dramatically different readings.

• Check your weight at the same time of day each time. With food and water

intake, you can easily gain and lose a few pounds in the course of a day.

Usually, you will be heavier in the evening.

• In gauging the success of your weight loss, about 1 pound per week is a

healthful goal. It is about what you can expect if you follow the diet

presented in this book without doing particularly vigorous exercise. Slower

weight loss is also fine as long as you are moving in the right direction.

• Do not rely on exercise alone for weight loss. A healthful diet change can

easily trim 300 to 400 calories a day off your daily menu, but burning that

many calories through exercise means walking or running 3 or 4 miles a day.

Exercise is important, but it cannot begin to take the place of diet changes.

CHECKING YOUR EYES

At least once a year, you should have an eye examination by an ophthalmologist

to check for any sign of retinopathy. These changes cannot be detected by an

ordinary eye examination with a doctor’s ophthalmoscope or during an

optometric examination for eyeglasses. Also be sure to see an eye specialist if

you have had any changes in your vision.

If you smoke, tell your eye doctor. Yes, you will get a lecture, and it is time

to listen up if you are still smoking. See Chapter 13 for information on the

effects of nutrition on eye health.

CHECKING YOUR FEET

Foot problems are common in diabetes. If your blood glucose has been poorly

controlled, you are at risk of developing neuropathy—nerve damage—which

means you may not be aware of small injuries to your feet. Wound healing may

be slowed as well. Small injuries can gradually worsen and become infected.

For this reason, you not only want to get your diet into shape by following

the guidelines in this book, you also want to have your doctor check your feet at

least once a year. The examination will include a check for sensation using a thin

plastic thread, a check of your vibratory sense with a tuning fork, and a thorough

check for any signs of damage to your skin. Take the advice of Mary Ellen

Wolfe, RN, a nurse working with George Washington University, who

recommends that you take off your shoes and socks at every doctor’s visit to be

sure your doctor does not forget to examine your feet.

STAYING HEALTHY

No matter how healthy you get, you should still keep an eye on your glucose,

A1C, and cholesterol; blood pressure; weight; eyes; and feet. But I hope as you

tune up your diet and lifestyle, that it’s all you will be doing—just confirming

that all is just as it should be.

CHAPTER 8

A Perfect Diet in an Imperfect World

It is not always easy to follow a perfect diet in an imperfect world. There will be

times when those you depend on—restaurants, airlines, co-workers, and even

family members—have little understanding of or interest in healthy foods. This

chapter is dedicated to these situations. I will cover dining out, travel, social

situations, working with your doctor, and dealing with family members. When

life throws you a curve-ball, I will show you how to step up to the plate and stay

in the game.

DINING OUT

Dining out is part of life, and you ought to be able to enjoy a night on the town

with friends or loved ones without missing a beat on your new healthy diet.

Luckily, many restaurant menus offer plenty of healthy selections. Unfortunately,

others are limited. Often the key to success lies in where you go and what you

order when you get there. Here are a few tips.

First, think international. In Mediterranean countries, Asia, Africa, and

Latin America, the traditional dietary staples are grains, vegetables, legumes,

and fruits. Not surprisingly, all of these regions have historically had much lower

rates of diabetes than North America and Western Europe. When you choose

from the best of what these cuisines have to offer, dinner out can be both healthy

and delicious.

Italian restaurants are everywhere, and they would love to serve you

spaghetti with a marinara or arrabbiata sauce, minestrone, pasta e fagiole (a

traditional soup made with pasta and beans), healthy salads, chunky vegetable-

and-tomato pizza, grilled asparagus, and steamed spinach. Because their foods

are usually made to order, it is a snap for chefs to minimize oil, leave off cheese,

serve sauces on the side, and so on.

Mexican restaurants are ubiquitous in North America and serve bean or

vegetable burritos, veggie fajitas, rice, and salads. Most have stopped using lard

to make their beans, and all are happy to skip the cheese. Top foods with salsa if

you like.

Latin American cuisine comes in other wonderful varieties, too. Cuban and

Brazilian restaurants offer black bean dishes, rice, plantains, salads, salsa, and

other healthful fare.

Chinese restaurants will get you started with vegetable spring rolls or

vegetable pot stickers and various healthy soups. Favor the steamed, not fried,

items. Skip the meat dishes and get right to the long list of savory vegetable

main dishes made with tofu (also known as bean curd), green beans, broccoli,

spinach, and other healthful ingredients. The danger in Chinese restaurants, as in

most eating establishments, is overexuberance with the use of oil. Ask that your

food be prepared with as little oil as possible and have your main dish along with

plenty of rice, preferably brown rice.

Japanese restaurants are among the very best choices when it comes to

healthful dining. Sushi chefs are delighted to transform carrots, cucumbers,

radishes, sweet potatoes, and other simple ingredients into edible delights. Have

them along with miso soup, salads, seaweed, and various appetizers.

Thai and Vietnamese restaurants serve many meatless dishes that include

rice, soft noodles, vegetables, and tofu along with wonderful sauces.

Indian restaurants are mixed. While vegetarian diets are traditional and

highly respected among many Indians, the use of oil and dairy products often

puts them in the no-go zone. Your best choices are soups, rice dishes, and

vegetable curries prepared with minimal oil.

Ethiopian restaurants are common in major cities. Because some religious

groups in Ethiopia follow vegan diets during certain days of the week and

certain times of the year, the restaurants serve many dishes made with chickpeas,

split peas, lentils, green beans, peppers, and delightful spices. They will be

happy to serve you all their vegan items on a large platter for a wonderful dinner.

American restaurants, family restaurants, and even steakhouses have salad

bars and offer vegetable plates. Many serve pasta dishes even when they are not

on the menu.

Second, ask for what you want. If what you are looking for is not on the

menu, do not be afraid to ask. Most restaurateurs will gladly alter their main

offerings to accommodate a special request. If you would like cheese and bacon

bits left off your salad, if you would like a vegetable plate, or if you would like

your pasta topped with tomato sauce instead of meat sauce, by all means, ask.

You will not only get a better meal, you will also help the restaurant

management understand how to better serve patrons like you.

As I noted above, restaurant kitchens often overdo it with oils, so ask your

server how foods are prepared and request that your meal be made with as little

oil as possible. In Italian restaurants, spinach and broccoli are often sautéed, but

they can also be steamed. The same goes for most Asian vegetable dishes.

Sauces and condiments can always be served on the side. This goes for pasta

sauces, salad dressings, brown sauces used in Asian cuisine, spreads used on

sandwiches, and similar items.

Ask for what you want. You will be glad you did.

A Breakfast Trick

most restaurants will gladly serve a healthful bowl of oatmeal for breakfast and

will top it with strawberries, blueberries, or cinnamon. But once in a while,

you’ll find precious little at eateries that are busy serving bacon and eggs. Here’s

a trick:

Ask the server to have the cook throw some tomatoes, spinach, and

mushrooms on the grill. Maybe some asparagus, too. Chefs are accustomed to

stuffing them into omelets; now, you’re just having them without the eggs! With

a side of rye toast (no butter, of course), you’re set.

Fast Food

Fast food is rarely a top choice when the priority is healthy eating. On the other

hand, these chains are big businesses that understand the growing demand for

healthy food choices. More and more often, you find offerings on their menus

that fit into a healthy diet.

Taco Bell’s bean burrito—if you hold the cheese—is entirely vegan. If you

like, add tomatoes, lettuce, or jalapeño chile peppers.

Burger King offers a veggie burger that is much lower in fat than its other

sandwiches and will also gladly sell you a Veggie Whopper with all the toppings

but without the burger. Submarine sandwich shops will gladly leave off the meat

and cheese and pile on the lettuce, tomato, cucumbers, spinach, and peppers,

plus a dash of red wine vinegar. And they will even toast it for you. Denny’s

offers a veggie burger, and most family restaurants serve plenty of side

vegetables that together make a good vegetable plate.

Some fast-food restaurants offer salad bars. With chickpeas, three-bean

salad, cherry tomatoes, and chopped vegetables, a salad becomes a hearty meal.

In that vein, one of the best ways to get healthy food fast is to stop at any

large supermarket and patronize its salad bar. A wealth of great choices is right at

your fingertips.

NANCY’S AND VANCE’S EXPERIENCES

Nancy often dined with friends who liked good food and good restaurants. I

encouraged her to choose ethnic cuisine—Chinese, Japanese, Italian, or Thai, for

example. Unfortunately, that was not what most of her friends had in mind, and

they felt uncomfortable knowing she would not eat unhealthy things.

When she headed out to join friends at a restaurant that might not be very

accommodating, she often had a snack in advance so she would not be starving

when she got there. When she went to open houses during the winter holidays,

she often volunteered to bring a fruit and vegetable tray.

On a vacation to Iceland, she packed granola bars and individual soy milk

packages in her luggage, to supplement the local food, and got by just fine.

“I am tempted sometimes, especially when I am stressed or overtired. I talk

myself out of it,” she said.

She found it helpful to keep things in perspective. “You have to decide what

your priorities are,” she explained. “I didn’t want to suffer from the effects of the

disease. I wanted to stop the progression. I didn’t even think about reversing it.

And now I’m a walking advertisement for the program. People keep asking me

how I’ve done it. I’ve described it in detail to probably 40 people.”

When Vance dined out, he looked for veggie burgers, fresh steamed

vegetables, and pasta without cheese and oils. His challenge was sports

stadiums. “I love going to baseball and football games, where french fries, hot

dogs, and soft drinks are about all that’s offered. It would be great to be able to

bring in healthy food or even just some carrot sticks and a bottle of water, but

usually they don’t allow any food to be brought in. So at first I stuck to pretzels,

popcorn, and Crystal Light. At a game in Seattle, I smelled the fish and fries, and

it was hard to resist,” he said.

Veggie hot dogs and burgers came to Vance’s rescue. Although they are not

necessarily the ultimate dining experience, they are a major improvement on the

foods they replace, and more and more stadiums, movie theaters, and other

venues are starting to sell them.

TRAVEL

Travel presents challenges no matter what kind of diet you follow. Here are a

few ways to help keep your new eating plan on track.

Choose restaurants wisely. As you have seen, there are usually plenty of

vegan choices at nonvegan restaurants, particularly those that feature

international cuisine. Even some fast-food places can rise to the occasion.

You might go online to check out vegan and vegetarian restaurants in cities

you are planning to visit. A Web site called Happy Cow’s Vegetarian guide

(happycow.net) lists them by location, but call before you go; restaurants are

forever starting up and shutting down. There’s no reason to limit yourself to

these restaurants, though; almost any eating establishment should be able to

accommodate you.

Plan before you fly. When you are booking an international flight (or

generally up to 48 hours before your flight), request a vegan meal. You will get a

healthy meal and will often be served first.

On domestic flights, most meal service has gone by the wayside, so you

might pick up some easy-to-pack snacks at a health food store or supermarket.

Vegan deli slices are great sandwich fillers and resist spoiling. A pack of

hummus with pita bread, a few pieces of fresh fruit, some baby carrots, instant

soup cups (flight attendants will gladly provide hot water), or a small pop-top

can of chickpeas can be lifesavers.

SOCIAL EVENTS

It can be tough to stick to the plan at parties, even when you know you will

regret a slip in the morning. If you arrive at a party unprepared, there may well

be nothing available that you can eat. With a bit of planning, though, you can

celebrate without leaving the healthy path you are on. Here are some ideas.

Offer to bring a healthy dish. Let’s say you have been asked to the home of

some friends for dinner, and you have no idea what they will serve. Here is what

I suggest: When you get the invitation or as soon thereafter as possible, call your

hosts to let them know that you have changed your diet and that you do not want

to put them to any trouble. Say that you would like to bring something, such as a

low-fat hummus dip or an exotic fruit salad. I can almost guarantee that your

hosts will say there is no need to worry and you need not bring anything because

there will be plenty to eat. Now, regardless of what they were really thinking,

you have alerted them to your needs without imposing in the slightest.

If you are reluctant to let your hosts know, do not be. They will be much

more embarrassed if they find out after the fact that they served a dinner with

nothing you wanted to eat. Besides, you are very likely to find that other guests

—and even your hosts—are making similar diet changes.

Bring a healthy gift. Instead of the usual bottle of wine, why not arrive with

a healthful food gift? A fruit basket, a loaf of artisan pumpernickel bread, or a

healthy party dip (you can find all of these at health food stores) will delight

your hosts and ensure that you have something to eat.

Avoid arriving hungry. If you arrive ravenous, you will be drawn to the

platters of unhealthful foods. If you eat something before you arrive, you will be

fine.

Carry a plate. Party guests with nothing in their hands are inviting others to

offer them something. Make yourself a plate with a few crudités or a bit of

bread, and no one will be inclined to offer you foods you do not want to eat.

AT THE DOCTOR’S OFFICE

Medical care is a partnership; you and your doctor need to work together to best

meet your needs. This is true at any time, but especially when you are in the

process of changing your diet. The fact is, your diabetes will probably be

improving, and you will need to ratchet down your medications.

Some doctors are not easy to reach, and even if you have your doctor’s

attention, that does not mean he or she wants to engage in a conversation about

nutrition. Some physicians show little interest in the topic, while others have

frankly outdated or untested ideas about it.

I suggest you lend a copy of this book to your physician with a sticky note

flagging Chapter 14. It was written for doctors and shows them how they can

best help you.

You can help by holding up your end of the partnership. That means

following your doctor’s advice (provided it is sound and you agree with it),

letting him or her know how you are doing, calling promptly if your blood

glucose drops below 70 mg/dl (3.9 mmol/l) or whatever other criterion is set,

and taking a vitamin B

12

supplement so he or she will not worry about your

developing any sort of deficiency. The truth is, your nutrition is much better on a

vegan diet than on an omnivorous diet, but a knowledgeable doctor will want to

be sure you are getting your B

12

. A supplement will easily take care of that.

In the vast majority of cases, doctors are delighted when their patients

improve their diets. They are all the more delighted when they see the

improvements on the scale and in laboratory results.

One of our research volunteers thought his doctor would be skeptical about

his plans. They talked about little aside from blood tests and prescriptions during

his appointments. To his surprise, however, when the doctor found out he was

starting a vegan diet, she was delighted. “That will probably help you a great

deal,” she said. And indeed, it did. Within 6 months, he lost 30 pounds, was able

to stop one of his two diabetes medications, and was continuing to improve week

by week. His doctor had no formal education in nutrition, but she knew success

when she saw it. She now recommends the same diet to other diabetes patients.

LOVED ONES WHO HELP AND HURT

Sometimes our friends and family members help us stay on a healthy path. When

we are not enthusiastic about exercising, they encourage us by going with us.

When we are tempted by some less-than-healthful food, they shore up our

resolve.

Improving our diets is like quitting smoking or breaking any other habit: We

need our family’s support. But sometimes, intentionally or unintentionally, our

loved ones are not so helpful. They may not be aware of the risks of a bad diet,

or perhaps they are all too aware and are struggling with unhealthful habits of

their own. They may even try to sabotage your efforts to break bad habits.

If the problem is that your loved ones simply do not have much information

about healthful diets, lend them this book. If they are not eager readers, try this

little trick: Put a sticky note or bookmark at any page you think they would find

of special interest. They will be drawn to that section, and once they start

reading, they will probably continue.

If family members tease you about your eating habits, remind them how

important your health is to you. Explain that it is tough for you to have

unhealthful foods around and that you really need their help. Ideally, they will

join you in your new, healthy way of eating. If they just will not change, then at

a minimum, they must keep their food separate and not tease or tempt you with

unhealthy items.

GOOD FOOD FOR THE WHOLE FAMILY

If you are preparing meals for your family and they are balking at new foods, do

not despair. It is natural to be cautious about anything new. Present healthful

foods without pushing them and recognize that it often takes a couple of tries

before a new item really catches on.

I suggest that you not fix healthy meals for yourself and less-than-healthy

meals for your spouse or children. Some people do this, figuring they cannot

change others’ bad habits. But remember this: Not only will introducing

healthful foods to your family bring you some very important allies, it will

benefit your loved ones as well as you.

The very best situation is when the whole family decides to change together.

There is no health reason for anyone to eat animal-derived foods, fatty foods, or

sugary foods. Yes, these foods are everywhere in modern societies, but they are

the principal reason for the epidemics of overweight, heart disease, cancer, and

other health problems in North America and much of the rest of the world. When

the whole family makes the same diet change, they all get the same advantage.

One good way to break through resistance is to ask your family members to

try a short-term diet change with you as an experiment. Say that you’d like to try

new and healthy ways of eating for just 3 weeks, and you would like them to

join you. Most people will try anything for a short period. By the time 3 weeks

have passed, they will have sorted out the new foods they like and will be ready

for more.

When introducing healthful foods to children, it is generally best to stick to

simple, familiar items. Some children may not yet care for exotic vegetables, but

they will easily gravitate to fruit of all kinds, as well as corn, green beans,

carrots, peas, and other simple foods. Avoid wrangling with a child who is

reluctant to try a new food. Sometimes altering the form of the food makes a

huge difference. A child who does not care for the texture of cooked spinach

may like fresh spinach as part of a salad. Steamed broccoli and cauliflower may

be intimidating, but they may be perfectly acceptable when chopped and added

to a soup or stew. Kids may not go for lentil loaf, but they love veggie burgers

and hot dogs and sandwiches made with vegetarian deli slices.

It always helps to present choices. Would your children prefer baked beans

or lentil soup? Would they prefer their veggie burgers cut into halves or

quarters? The idea is to give kids a sense of control while all the possibilities are

good ones.

In some families, food is a symbol of affection. Parents stuff their children

with cookies and gooey desserts, as if love could be measured in calories.

Whatever the motivation, none of this does you one bit of good. Find other ways

to express affection. A book, a walk, a trip to the movies—there is no shortage of

meaningful gifts.

HEALTHFUL FOODS IN AN UNHEALTHY WORLD

A visitor from another planet might well conclude that modern civilization has

no perceptible interest in healthful diets. Fast-food restaurants—and regular

restaurants—carry lots of fatty, cholesterol-laden meals and far fewer healthful

choices. Television commercials push endless less-than-healthful snacks.

Convenience stores and snack machines offer lots of what you do not want and

precious little of what you do want. Sometimes, you may feel like a person who

is trying to quit smoking but is trapped in a bar where cigarettes are free.

In large part, you would be right, but truly, there are also plenty of healthful

options. For every convenience store selling unhealthy food, there is a

supermarket with an ever-expanding range of great food products. For every

restaurant that refuses to serve anything health-conscious eaters would look for,

there are a dozen that offer good choices. The range of health-oriented

cookbooks is truly enormous, and it is now easier than ever to follow a healthful

diet. Friends and family members—even those who do not follow healthy diets

themselves—all know that what you are doing is worth supporting.

CHAPTER 9

Troubleshooting

How are you doing with your new way of eating? Are you reaching your weight-

loss goals? Are your glucose and A1C coming down? Is your cholesterol

improving?

If you are having any sort of trouble, this chapter will guide you through the

most common problem spots.

NOT LOSING WEIGHT

People who begin low-fat, vegan diets typically lose weight easily. In our

research studies, the average rate is about 1 pound per week. Some people lose

more quickly, others a bit more slowly, but a pound a week is a good pace. If you

think about what this means over a year’s time, the result is impressive,

particularly since you are free of the yo-yo syndrome that comes with diets

based on calorie restrictions. Because this is not a short-term, starve-yourself-

thin diet, it does not cause hunger, so there is no rebound bingeing. Gradual,

healthy weight loss is what you can expect. Sometimes losing weight can be a

bit like following the stock market. There are fluctuations up and down, but the

trend should be clear. If you are not losing weight, it is time to take action. Here

are the steps to take.

Get back to the basics. Be sure you are following the guidelines in Chapter

4 and giving it 100 percent. That means no animal products in your diet at all. If

your diet includes fish or cheese, for example, your weight-loss efforts will be

hampered.

Check for hidden oils. Packaged foods should include no more than 3 grams

of fat per serving. If you frequently eat at restaurants, try to assess to what extent

they are packing oils into their meals. If you are unsure (or your server is

unsure), ask for foods to be steamed rather than fried or sautéed and that any

sauces or dressings be served on the side. See Chapter 8.

Do a Quick Fiber Check. If you check your fiber intake and find that you

are eating less than 40 grams of fiber per day, you’ll want to bring in more

beans, vegetables, and fruits.

If your diet is vegan, low in fat, and high in fiber, it is very hard not to lose

weight. Even so, here are a few things to consider.

Simplify. It pays to choose simple foods rather than processed food products.

The fewer ingredients, the better—one is ideal. Beans, broccoli, carrots, or

brown rice, for example, do not need an ingredients list, because what you see is

exactly what you get. You know that no one has added any oil or processed away

any fiber.

Add more raw foods. Some people have had remarkable weight loss as a

result of increasing their intake of raw foods. Chopped vegetables, salads, fresh

fruit—these are all rich in fiber, with no added fat and low GIs.

Don’t Get Sidetracked by Rationalizations

Sometimes people who are not losing weight blame genetics, lack of exercise, or something

else for their problem. Genetics and exercise do play roles, of course. But if you are not losing

weight, the problem is nearly always dietary.

Once, en route from Washington to London, I was busily typing away on my laptop, writing

an article about diet changes for weight loss. The passenger next to me happened to see what

I was typing and took an interest in the topic. He had been overweight for several years and

wanted to see what I might suggest. I explained our research findings about how diet changes

could cause lasting weight loss. I pointed out that the key seemed to be changing the types of

foods we eat. I launched into a discussion of the benefits of vegetables, fruits, beans, and

whole grains and the wonderful meals they can become.

“That’s interesting,” he said, “but I think I just need to exercise more. That’s my real

problem. I used to exercise a lot, but lately, I’ve been so busy.” He brushed aside the whole

topic of food.

A few minutes later, the flight attendant came by with the meal service. She served him a

ham-and-cheese sandwich, a bag of chips, and a soft drink, which he shoveled into his mouth

without a word. I suspect he did not realize that it would take a very long session at the gym to

burn away those unnecessary calories. The airline also served vegetarian meals, which would

have been a much better choice.

Shortly thereafter, I was talking to a patient with Stanley Talpers, MD, an internist on the

faculty of the George Washington University School of Medicine in Washington, D.C. The

patient said he hadn’t been losing weight, and he figured that he just needed to walk more. Dr.

Talpers encouraged him to get his diet in order first because, he said, “to lose a pound by

walking, you’d have to walk to Baltimore.” It is true. Exercise is beneficial, and I strongly

recommend it. But a lack of exercise is not the primary reason for weight problems, and

exercise can never take the place of a healthful diet.

BLOOD GLUCOSE NOT COMING UNDER CONTROL QUICKLY

ENOUGH

The primary way of tracking your glucose control is with hemoglobin A1C. As

you know, the American Diabetes Association’s goal is to have your A1C under

7.0 percent. If you are not making good progress toward your goal, here are

some points to consider.

Get back to the basics (again). If you are overweight, weight loss is the

strongest predictor of a healthy drop in A1C. To jump-start weight loss, take a

look at the tips above and in Chapter 6. Whether you are overweight or not,

those same points are also the keys to bringing your glucose under control.

If your diet is vegan, it has no animal fat in it, of course. And if you are

setting aside vegetable oils, it has very little of any kind of fat. With these

healthy changes, you can just imagine those little bits of fat inside your muscle

cells starting to shrivel up. As you saw in Chapter 2, these are the bits of fat that

appear to be the cause of insulin resistance.

Embrace healthy carbohydrates. Many people tie one arm behind their

backs by avoiding starchy foods. They imagine that beans, lentils, pasta, sweet

potatoes, or yams will push their blood glucose upward. And, of course, if you

check your blood glucose after just about any meal, it will be higher than it was

before. However, don’t let this turn you against starchy foods and back toward

fatty or high-protein foods. Here is why.

The fat in fish and chicken will tend to arrest your weight loss. It will also

tend to aggravate your insulin resistance. Here is what happens in a typical case.

A man has heard that “carbs are bad” or perhaps notices that his blood

glucose has gone up briefly after a meal of rice or starchy vegetables. He decides

to avoid carbohydrates and adds fish and chicken back into his diet. At first, it

seems like a good change. His blood glucose does not spike strongly after meals

because there is very little starch in his meals to provide glucose. “Aha!” he

says. “I’ve found the diet to keep my blood sugar down!” over the next several

days, however, he notices that his fasting blood glucose values are heading in the

wrong direction. They go up bit by bit, and after a week or two, the rise is

significant. “Now what?” he thinks. This is what is going on:

There are only three sources of calories: carbohydrate, fat, and protein. In

avoiding carbohydrate, he was left with fat—which tends to increase insulin

resistance—and protein, which has problems of its own. The increased fat intake

did not increase his blood glucose immediately, but fatty diets tend to increase

the amount of fat inside the cells. The result is that insulin resistance gradually

worsens. This means that any carbohydrate he ate later would cause a bigger

blood sugar spike than it otherwise would have. As the days went by, his blood

sugar gradually increased.

The answer to this is to avoid fatty foods and choose healthy, carbohydrate-

rich foods, letting the glycemic index help you choose the best of them (see

Chapter 4). This means legumes (beans, peas, and lentils), vegetables, fruits, and

whole grains.

Meals will always cause a temporary rise in blood glucose; what you are

looking for is an overall trend downward as your insulin sensitivity gradually

improves.

See your doctor. One common reason for rising blood glucose levels is

infection. A cold, a urinary tract infection, a foot sore, an ear infection—you

name it. They all tend to raise your blood glucose. Sometimes a surprisingly

small cut or a cough you’re hardly aware of boosts your fasting blood sugar

values. As the infection heals (with medical treatment as needed), your blood

glucose will recover. Your doctor may decide to adjust your diabetes medications

in the interim.

Check your stress level. Stress raises blood sugar. The fight-or-flight

response—the physical reaction that gets you ready to fight or run away from

danger—can kick in with any sort of threat, real or imagined. A rise in blood

sugar was much more useful when the threats we encountered were predators

and warring tribes. That extra blood sugar fueled the muscles needed to run or

fight. Today, we are more likely to be threatened by job worries, financial

difficulties, or relationship problems, and rising blood sugar doesn’t help during

those times. But stress still evokes the response, and it still causes a blood sugar

spike.

If stress is temporary, you will see your glucose spike resolve quickly. If

stress is ongoing, get help. Meditation, yoga, and other techniques can help you

deal with stress. If the problem is deeper—if you are headed into depression or

chronic anxiety—do not try to be a hero. See a qualified mental health

professional and get started with a treatment that works for you.

Exercise. If you are sedentary, now is the time to bring physical activity into

your life. Vigorous exercise helps reduce blood glucose levels. See Chapter 11.

In most cases, these steps will help bring your blood sugar down. If it

remains high despite your best efforts, your doctor will want to adjust your

medications.

PERSISTENT HUNGER

If you are cutting back on calories in an effort to lose weight, you may be left

feeling hungry. One of the reasons I recommend a low-fat, vegan diet is that it is

so substantial—it provides plenty of fiber to fill you up and has no limits on

portion sizes or calories. The result is weight loss without hunger. In our

research studies, we use a questionnaire to measure hunger along the way, and

we consistently find that this way of eating leaves people feeling satisfied.

What if your meals don’t quite hold you, though? Here are some suggestions,

starting with the obvious one.

Eat more. Maybe that little bowl of oatmeal is just not enough. When you

are just getting to know new foods, it takes a little time to figure out the right

serving sizes. You will soon sort this out.

Go low GI and high fiber. If you have instant oatmeal for breakfast, you

will get hungry sooner than if you have the old-fashioned variety. The difference

is simply that instant oats have had their fiber sliced up. Instead of flat rolled

oats, you have a box full of oat powder. That means that they cook quicker but

also that they digest quicker, spike your blood sugar quicker (that is, they have a

higher GI), and leave you hungry quicker. Eating foods that are in as natural a

state as possible prevents that overly rapid digestion and helps keep hunger at

bay.

You want foods that have both a low GI and high fiber content. A food that

offers one doesn’t necessarily have the other. For example, whole wheat bread

has lots of fiber, but something about the wheat grain causes it to release its

natural sugars into the bloodstream rather quickly (i.e., it has a high GI). In fact,

white bread (which has had its fiber removed) has virtually the same GI as whole

wheat. In contrast, rye bread digests more slowly, releasing its natural sugars into

the bloodstream more gradually, which means it has a low GI. To check your

fiber intake, do a Quick Fiber Check.

Have healthy snacks. There will be many times when you will want to have

a bite to eat between meals, and you should! See Chapter 5 for a discussion of

the best choices.

QUIETING CRAVINGS

If you have had diabetes for any length of time, you have already been coping

with the ubiquitous nature of junk food. Unhealthy snacks are everywhere. But

why do they call to us as they do? Why is sugar or chocolate sometimes so

attractive? Why is cheese or meat sometimes hard to resist? Where do cravings

come from?

One of our research participants once asked me what was wrong with her.

She had had diabetes for 12 years, and even though she knew that she should

stay away from sugary foods, she craved them. Especially when she was stressed

or tired, cookies, chocolate, and pastries seemed to call her name. She had the

cravings nearly every day. “I think I’m just a weak-willed person,” she said. She

was embarrassed about her cravings and found herself avoiding the subject when

she spoke to her dietitian.

Here is the most important thing to understand about cravings: They are not

caused by weak will or gluttony. Cravings are triggered by biological properties

of the foods themselves. That is, certain foods have chemical makeups that cause

us to crave them in very much the same way that drugs, alcohol, and tobacco

have addictive components.

Let me be clear: Only certain foods lend themselves to cravings. The same

foods are alluring to almost everyone.

Four types of foods trigger biochemical effects not unlike those of addictive

drugs. They are not as strong or as dangerous as drugs, but the chemistry of

addiction does seem to be at work with these foods. I have described these

effects in detail in a book called Breaking the Food Seduction. Here, I will

summarize the main points you need to know. The four categories of addictive

food are sugar, chocolate, cheese, and meat.

Sugar. Sugar is not simply sweet. In addition to its taste, it also has a mild

druglike effect. That is, it affects the brain in essentially the same way as opiate

drugs—morphine and heroin, for example—albeit not as strongly. This effect

helps explain why people crave sugar, especially during times of stress.

How do we know that sugar has this effect? In controlled studies, researchers

use a medication called naloxone as a research tool. Nalox-one is normally used

in emergency rooms to block the effects of heroin or other opiates. If a person

has overdosed on heroin, doctors inject naloxone, which blocks the heroin (and

any other narcotic) from attaching to receptors in the brain. A comatose drug

addict, previously on the verge of death, rapidly awakens with a dose of

naloxone.

Researchers have given naloxone to volunteers and offered them various

sugary foods. They then measured how much the volunteers ate and compared

the results to those of the same test done without naloxone.

It turns out that naloxone causes a noticeable drop in sugar cravings.

Normally, you might long for a glazed doughnut or piece of pie, but with a dose

of naloxone, much of the attraction is gone. The effect is particularly clear for

foods that contain both sugar and fat: cookies, cakes, and ice cream.

Naloxone is given intravenously and is not a treatment for food addiction; it

is a research tool. These experiments show that sugar does not simply delight the

taste buds; it also stimulates the release of opiate chemicals in the brain. Just as

intense exercise causes the release of endorphins—natural feel-good chemicals

within the brain—sugar seems to do something very similar.

Let me be clear about this: Sugar does not contain opiates. Rather, the taste

of sugar on the tongue is what apparently triggers the release of opiates within

the brain. In turn, these opiates trigger the release of another natural chemical,

called dopamine, which is the key to the brain’s pleasure centers. Drugs of abuse

—heroin, cocaine, marijuana, tobacco, alcohol, and all others—increase

dopamine activity in the brain. Sugar appears to do the same. Evidence suggests

that the effects of sugar on the brain ease pain and discomfort and give us a little

boost. No wonder we turn to sugary foods, especially when we’re stressed.

Sugar has the same effects on infants just a few hours old. When babies have

a heel-stick to draw a blood sample, they cry noticeably less if a bit of sugar

water is dribbled into their mouth first.

Sugar cravings go beyond plain sugar itself. Some people also crave foods

such as white bread or bagels, which turn to sugar rapidly and release sugar into

the bloodstream. In essence, they crave high-GI foods—sugar, cookies, crackers,

white bread, potatoes, or cold cereals. While we also enjoy low-GI foods, we

tend not to crave them.

Chocolate. Chocolate’s addictive qualities have long been recognized in

psychiatric journals. And in scientific studies, the most ardent chocoholics’

desire falls away when they are treated with opiate-blocking drugs. These

experiments show that it is not simply taste or mouthfeel that keeps us hooked.

Chocolate also appears to have mild effects on our brains.

Chocolate’s attraction is not due simply to its sweetness. After all, no true

chocolate lover would be satisfied with sugar alone. Chocolate also contains

caffeine, theobromine, and phenylethylamine. These are all stimulants, and they

may play a role in chocolate’s seduction, aside from its opiate effects.

If you are a chocolate lover, you probably already know that chocolate is

more than a food: You don’t just feel you want it, you feel you need it.

Regrettably, chocolate carries not only a load of sugar but also a considerable

load of fat.

Cheese. Yes, it may smell a bit like old socks, but cheese is one of the foods

that people who are trying to improve their diets have the most trouble leaving

behind. There is obviously something besides fat and cholesterol in cheese that

accounts for its popularity.

That “something” may be the dairy protein, or casein. Like all proteins,

casein’s molecular structure is like a long string of beads, with each bead being

an amino acid. Normally, when proteins are digested, these amino acids come

apart one by one and are absorbed into the bloodstream to be used to build body

tissues and repair any damage to your body.

Casein behaves differently. As it breaks apart, it does not simply release

individual amino acids. It breaks into short strings of amino acids—strings of

perhaps four, five, or seven “beads.” They are not just the amino acid building

blocks for protein; they are also biologically active compounds with a mild

narcotic action. Scientists call them casomorphins—casein-derived morphinelike

compounds. If scientists were to feed you cheese and then take a sample of your

digestive tract contents, they would find an array of casomorphins with mild

narcotic actions. Some have speculated that the narcotic effects of casomorphins

are responsible for cheese’s attraction. These effects may also explain why

cheese can be constipating, since narcotic compounds slow digestion.

By now you know if cheese is your thing. If so, its fat and cholesterol

contents are conspiring against you. Shortly, we will look at how to kick this and

other food addictions.

Meat. Men, in particular, often describe meat as the very last food they

would ever want to give up. No matter how often they are reminded of what it is

doing to their waistline or cholesterol test results, many have trouble breaking

their emotional attachment to roast beef, steak, or chicken wings.

Once again, experiments with opiate-blocking drugs suggest that part of the

desire for meat may have its basis in opiate effects within the brain. Researchers

in England gave opiate-blocking drugs to volunteers and tested their desire for

ham, salami, and tuna. The results showed that when the opiate effects were

blocked, volunteers lost much of their interest in meat.

1

RESETTING YOUR PRIORITIES

If cravings are sabotaging your new food program, take heart. You are not the

victim of a bad upbringing or a gluttonous personality. The fact is, you are not

attracted to just any food, or even to most foods. You may like apples, oranges,

bananas, or asparagus, but you have never once turned to them for solace during

moments of stress. You have never raced off to a convenience store because you

just had to have cauliflower. You have turned to sugar, chocolate, cheese, or

meat because they have chemical effects on the brain. Some beverages, such as

wine or coffee, also have druglike effects and can be addictive. But as far as

foods go, those four are the ones that work their unfortunate magic on just about

everyone.

Before we see what you might eat instead of that sugary doughnut, candy

bar, or cheeseburger, let’s take a closer look at what happens inside your brain

when you eat these foods.

A network of cells deep inside the brain makes up what is sometimes called

your reward center. Indeed, it is responsible for feelings of pleasure. Without it,

life would be one big gray day.

The reward center is not there just for fun, however. It is there to keep you

alive and to maintain the species. Here is why: If you got absolutely no pleasure

from eating, you might forget about foods entirely! Likewise, if sex were a total

bore, the species would soon die out. Thus, when you eat or have sex, your

reward center gives you a little bit of dopamine as a kind of reward.

In the process, that dopamine release causes slight neurological changes,

changes that put high-priority status on repeating whatever you have just done.

“That was fun,” your reward center seems to say. “Let’s be sure to do that

again.”

In nature, this would mean getting a reward for finding a new food source or

a receptive mate, with the result that you would take advantage of your find

again and again. The problem is that this system is easily hijacked. Alcohol,

recreational drugs, tobacco—and yes, unhealthy foods—cause significant

dopamine release, so not only do you like them, you also want to have them

again and again. Your pleasure center rearranges your priorities to favor

whatever stimulated it most recently. You find yourself planning your day

around sugar or chocolate, just as an alcoholic might regularly think about where

the next drink is coming from. If you have ever wondered why these otherwise

banal foods have such sway, it is because they hijack your brain’s pleasure

circuitry and your internal priority-setting system.

Breaking Free

If the occasional taste of sugar or chocolate is really not a big part of your life,

there is no need to worry about it. But if your waistline is expanding before your

very eyes, or your health is suffering from your food habits, it is time to wake up

and smell the addiction. What do you do if you’re hooked?

The best way to deal with unhealthy foods is to avoid teasing yourself. Set

them aside completely, at least for now. Do not keep them in the house, and do

not buy them. There is no need to worry about whether you will return to them

in the future. For now, just leave them alone.

In the process, your brain’s priorities can return to what really is good for

you. You are likely to find that your desire for unhealthy foods fades the longer

you are away from them. The following steps will also help.

• Eat a healthy breakfast, and don’t skip meals. Cravings kick in when you are

hungry.

• Get regular exercise so you’re tired enough to sleep soundly, and be sure to

get plenty of rest. Cravings are stronger when you are not sleeping well.

• Avoid situations that trigger cravings. Some people find that their cravings

are triggered by being alone, by television cooking shows, by concession

stands at movie theaters, or by certain friends who are preoccupied with food

problems of their own. Try to identify your triggers and eliminate them as

much as possible.

Getting the Taste without the Regrets

Sometimes a simple substitution can help you steer away from an unhealthful

food. Here are a few.

If you crave sugar: In recipes, maple syrup, molasses, sorghum syrup, and

granulated sugarcane juice (Sucanat) can sometimes substitute for table sugar.

These are hardly health foods! But the idea is to replace refined white sugar with

a smaller amount of syrup or juice. They’re so flavorful you won’t notice you’re

using less.

Stevia is an intensely sweet derivative of an herb from Paraguay. It is sold as

a dietary supplement (its use as a commercial food additive has not yet been

approved).

Sucralose (Splenda) is a calorie-free sweetener made from cane sugar to

which chlorine has been chemically added, greatly increasing the sweetness of

the final product. Sugar alcohols, such as mannitol, sorbitol, and xylitol, are low-

calorie sweeteners sometimes used in candies, chewing gum, and desserts. They

have about half the calories of table sugar. There are, of course, other artificial

sweeteners. The disadvantage of the lot of them is that they do not help you

break your love affair with sweets, so when artificial sweeteners are not

available, you will find yourself returning to sugar.

My friend and colleague Hans Diehl, DrHSc, founder of the Coronary Health

Improvement project, says the best thing to do for a sweet tooth is to “have it

pulled!” The idea is that if you set sweets aside, you will eventually just forget

about them.

Of course, the best choices are fresh fruits—nature’s sweet foods. It also

helps to make sure your diet has adequate complex carbohydrate—grains, sweet

potatoes, and beans, for example. These foods provide the energy you need in a

form that is much more healthful than sugar.

If you crave chocolate: Cocoa powder is essentially defatted chocolate. It

can be used in beverages and baking or turned into a dip for strawberries or other

fresh fruit. You can also find low-fat frozen ice cream substitutes made from soy,

as well as sorbets.

If you crave cheese: get to know nutritional yeast. Sold in the supplement

aisle of health food stores, nutritional yeast flakes (not brewer’s or baker’s yeast)

add a cheeselike flavor to sauces and casseroles.

In recipes, you can replace ricotta or cottage cheese with mashed, water-

packed tofu mixed with a little lemon juice. If you’re choosing soy cheeses, read

the label to check the fat content and to see whether they’re made with added

casein, the dairy protein.

If you crave meat: Good substitutes for hot dogs, burgers, and deli meats

are now widely available. Seitan (made from wheat gluten), tofu, tempeh, and

textured vegetable protein are versatile products that substitute well for meat in

recipes. Surprisingly enough, the desire for meat fades very rapidly once it is

removed from the diet. People who thought they could not live without steak or

a salmon fillet soon find they have absolutely no desire for it.

Genetic Influences on Cravings

Although cravings can affect anyone, some people may be especially vulnerable.

Researchers have found that some people are born with fewer receptors for

dopamine, the brain chemical responsible for pleasurable feelings. Apparently,

this lack of receptors means that they get less dopamine stimulation and less of

the feel-good sensation that dopamine provides. This leaves them feeling a bit

out of sorts compared with other people. As a result, they are drawn to tobacco,

alcohol, or drugs; presumably, they are seeking the stimulation that nature has

not given them. They may even fall prey to compulsive gambling or compulsive

eating.

It all starts with a gene. The receptors for dopamine are built according to the

specifications on your chromosomes—the long spiral staircase–shaped strings of

genes in each of your cells that determine who you are. Your mother and father

passed along their genes to you, and the makeup of your body reflects the

combination of the two. If either parent passed along a gene for having too few

dopamine receptors, you would have roughly one-third fewer receptors than

other people.

If you were able to sample individuals in smoking cessation programs or

drug treatment clinics, you would find that as many as 40 percent have a gene

that causes them to have too few receptors, called dopamine receptor D2, or

DRD2 for short.

Several years ago, I found myself wondering if people who have trouble

following a healthful diet may have this genetic variation. Ernest Noble, MD, of

the University of California, Los Angeles, conducted genetic analyses on our

patients. To our surprise, we found that nearly half of our research participants

with type 2 diabetes had the gene that was associated with fewer than normal

dopamine receptors. That is far higher than the roughly one-in-five prevalence in

the general population.

This raised a disturbing question: Did the lack of dopamine receptors lead

them to overeat? Did overeating then lead to weight gain, which in turn triggered

diabetes? We have not yet sorted all this out, but we did find that while people

with this gene improved a great deal on our diet, they got somewhat less benefit

compared to those with the normal number of dopamine receptors. Their A1C

values dropped by about 0.9 percentage point on average, compared to a drop of

1.6 points for those without the gene. At present, this type of genetic testing is

done only in research studies. Your doctor cannot determine whether you are

genetically endowed with fewer dopamine receptors. In fact, as far as your food

plan is concerned, it does not matter. Regardless of your genetic makeup, the diet

described in this book is very likely to help you. I raise the issue of genetics

simply to underscore the point that cravings and food addictions are physical,

not moral issues. They are due to the properties of foods themselves that interact

with our natural biochemistry.

One final point: If certain foods act like drugs, it pays to treat them like

drugs. In other words, avoid them. Just as it is harder for a smoker to cut down

than to quit and harder for an alcoholic to drink wine moderately than to quit

drinking altogether, it is very tough to tease yourself with foods that have you in

their clutches. It is actually easier to leave them alone completely and do your

best to forget about them. If you have not had one of these biochemically active

foods in a few weeks, you crave it much less than you would if you had it

yesterday.

The brain cell at the top contains small packets (vesicles) of dopamine. When you experience a

pleasurable sensation, these vesicles release their dopamine into the space (synapse) that lies

between that cell and the next one. As the dopamine molecules reach the next cell, they attach to

its dopamine receptors, and their effect depends on how many dopamine receptors you have.

Some people have approximately one-third fewer receptors than other people.

DIGESTIVE PROBLEMS

A plant-based diet is great for people who have been bothered by constipation.

Its natural fiber is what your digestive tract needs. Some foods can cause a bit of

gassiness, however. If you experience this, here is what to do about it.

First, only certain foods cause gas. Grains, fruits, and most vegetables get a

not-guilty verdict. Beans and undercooked cruciferous vegetables (broccoli,

cabbage, cauliflower, and Brussels sprouts, for example) are the main culprits.

Chances are, all you need to do is have smaller servings. If you have been

replacing a huge steak with a huge plate of beans, remember that a small amount

of beans goes a long way. Try downsizing your portions.

Over time, you will find that your body adjusts, so you can have larger

portions with less gassiness. If you cook beans from scratch, be sure to discard

the water used to soak them and then cook them in fresh water. Cook them well

(there are no al dente beans)! The same goes for cruciferous vegetables. Yes, we

all love a stalk of fresh broccoli from the crudités tray, but if that gives you

digestive trouble, cook vegetables until you can easily pierce them with a fork.

It goes without saying that you want to avoid dairy products and sugar. Dairy

products, of course, are already off the list, but digestive problems are yet

another reason to steer clear of them, as you saw in Chapter 4. The lactose (milk

sugar) that makes up fully 55 percent of the calories in fat-free milk causes many

people to have gas, cramps, and diarrhea. Here is why.

During infancy, the lactase enzyme is produced within the body and breaks

lactose apart in the baby’s intestinal tract so it can be absorbed and used for

energy. As children leave infancy behind, however, most lose this enzyme. The

result, lactose intolerance, was once thought to be abnormal, but it is now known

to be the biological norm, not only for humans but for all mammals. Because the

body’s lactase production slacks off gradually, many people do not make the

connection between their digestive symptoms and milk products.

In about 85 percent of Caucasians, a genetic mutation causes the lactase

enzyme to persist well into adulthood. Even so, lactose intolerance will

eventually affect many of them, too. Deleting dairy products from the menu for a

few days will show you whether you are among them.

Some adults have trouble digesting table sugar (sucrose). Once again, it is

easy to check. Simply set it aside for a few days and see if your symptoms

improve.

HIGH TRIGLYCERIDES

When your doctor checks your cholesterol, triglycerides will also be listed on the

laboratory report. Triglycerides are molecules of fat that are transported in the

blood for various purposes. As with cholesterol, having a certain amount of

triglycerides in the blood is a normal part of human biochemistry. However,

when triglycerides are high, they increase the risk of heart problems, diseases of

the pancreas, and other problems. As you saw in Chapter 7, a normal triglyceride

concentration is less than 150 mg/dl. Values of 150 to 199 mg/dl are considered

borderline, and values of 200 to 499 mg/dl are high. Concentrations of 500

mg/dl or higher are considered very high.

Some studies have suggested that diets high in refined carbohydrates may

cause a temporary rise in triglycerides. High-fiber and low-GI foods appear to

have the opposite effect.

2

You will want to make a special point of favoring these

foods. In our research, a low-fat, low-GI, vegan diet brings down triglyceride

levels very effectively. In addition, a low-fat, vegan diet helps you lose weight,

which in turn reduces triglycerides.

Regular exercise helps, too. Moderate physical activity, such as walking,

lowers triglyceride concentrations. You will also benefit by avoiding alcohol.

Alcohol appears to raise triglycerides slightly, so when you avoid it, triglycerides

slide back down.

INTERACTION BETWEEN VEGETABLES AND PRESCRIPTION

BLOOD THINNERS

Warfarin (Coumadin) is a blood thinner prescribed to prevent heart attacks,

strokes, blood clots in the legs, and other problems. It acts by antagonizing the

effects of vitamin K, which is involved in building the proteins your body uses in

the clotting process.

Many people taking warfarin believe they have to avoid vegetables,

especially green leafy vegetables, that are rich in vitamin K because the vitamin

will affect their tendency to form clots. But avoiding these healthful foods would

leave them very low in important vitamins and minerals.

I encourage you to discuss this issue with your doctor and your dietitian, but

the answer is not to avoid vegetables. What matters is maintaining a fairly steady

amount of them in your diet so your warfarin dosage does not need to be

continually adjusted. If you eat lots of healthy vegetables and then suddenly

stop, warfarin’s actions become stronger, increasing the risk of bleeding. On the

other hand, if you were to generally avoid vegetables and one day suddenly

increase your intake, the vitamin K in these foods would have the opposite

effect, making it easier for your body to form clots. Bottom line: Enjoy

vegetables and keep the amount fairly constant from day to day.

By the way, alcohol increases warfarin’s effects, which is why doctors

encourage people taking it to avoid alcohol. Many medications (e.g., aspirin,

acetaminophen, and many others) can also accentuate warfarin’s action.

If you have hit any bumps in the road, I hope you have found these

suggestions helpful and that you are now back on track with a healthful diet.

CHAPTER 10

Which Supplements Should You Take?

News stories and advertisements trumpet the benefits of various nutritional

supplements. Drugstores and health food shops are stocked with shelf after shelf

of them. Which ones help, and which ones are unnecessary?

Here is some basic information that will help you decide. You should,

however, talk to your doctor, nurse practitioner, pharmacist, or dietitian about

which products you may take. You may have a particular need for one or another

supplement depending on your health. Or you may need to avoid certain

products because they interfere with medications you are taking.

If you are adding supplements that might affect your blood sugar, be sure to

check your blood glucose regularly. Refer to Chapter 7 for how to recognize and

treat low blood sugar.

Let’s look at specific vitamins and other nutritional compounds, starting with

the basics.

Vitamin B

12

. This vitamin is essential for healthy blood cells and nerve

function. If you follow a vegan diet, as I recommend, you should take a daily

vitamin B

12

supplement that provides at least 5 micrograms. Nearly all brands

contain more than this, but higher doses are not toxic. Many people, particularly

older people, tend to run low on vitamin B

12

regardless of their diets, because

their bodies become less efficient at absorbing it. That is also true of people

taking metformin or acid-blocking medications. Yes, you can find vitamin B

12

in

some fortified products, such as breakfast cereals and soy milk, but the amounts

may not be enough to meet your needs.

Vitamin D. Vitamin D is produced when your skin is exposed to sunlight. It

helps you absorb calcium, among other functions. It is a good idea to spend 15 to

20 minutes daily outdoors. If you get this sun exposure, there is no need for

dietary supplementation. If you do not and also do not take a regular

multivitamin, a 2,000 IU vitamin D supplement is a good idea.

Aside from the basic vitamins, some other supplements have shown promise

for people with diabetes.

Cinnamon. Cinnamon has been shown to improve blood sugar levels. As

little as ½ teaspoon of ordinary cinnamon added to your morning oatmeal or

other foods not only seems to reduce blood sugar, but also appears to reduce

blood cholesterol levels.

1

Some of cinnamon’s helpful effects may be explained

by compounds called polyphenol polymers, which are found in the spice and

have an insulin-like action.

Magnesium. In harvard’s Nurses’ health Study, women who had more

magnesium in their diets had a significantly lower likelihood of developing

diabetes.

2

Apparently, magnesium increases insulin sensitivity and may increase

the secretion of insulin from the pancreas, which suggests that it may also be

helpful after diabetes has been diagnosed.

This does not mean, however, that you need a magnesium supplement. Foods

rich in magnesium include whole grains (grains with their natural fiber intact)

such as brown rice, barley, and oats, as well as green vegetables such as spinach

and Swiss chard. Many bean varieties are also rich in magnesium.

Chromium. Chromium is an element that helps insulin work better, meaning

that it helps the hormone escort glucose from your bloodstream into your cells.

Technically speaking, chromium is what is called an insulin cofactor—an

insulin helper, if you will. In the same way that you cannot use a jack to lift your

car if its handle is missing, insulin has trouble bringing glucose into cells without

chromium to help it work properly.

Chromium’s essential role was discovered only relatively recently. In the late

1960s, researchers found that chromium deficiency could lead to high blood

sugar levels.

3

In 1977, Canadian researchers described the case of a woman in

her midthirties who was receiving all her nutrition intravenously following

intestinal surgery. As time went by, she began to lose weight. Her blood sugar

started to rise inexplicably, and eventually, she developed nerve symptoms in her

legs that appeared to be diabetic neuropathy. Her doctors had to administer large

insulin doses to bring her blood sugar under control. Eventually, they gave her

chromium, which had been absent from her feeding formula. In just a few

weeks, her blood glucose fell to the point where she no longer required insulin,

and her nerve symptoms disappeared.

4

Chromium is naturally present in many foods, such as broccoli, green beans,

whole grains, nuts, and even coffee. Some experts recommend taking

supplements as well.

Which foods have it, and how much do we need? According to the Food and

Nutrition Board of the Institute of Medicine, the safe and adequate daily intakes

of chromium for adults ages 19 to 50 are 35 micrograms for men and 25

micrograms for women. For people over 50, the amounts are 30 micrograms for

men and 20 micrograms for women. Here is the amount of chromium in

common foods, as listed by the US government.

Chromium Content of Common Foods

FOOD PORTION CHROMIUM (MCG)

Broccoli ½ cup, cooked 11

Grape juice 1 cup 8

English muffin, whole wheat 1 4

Potatoes, mashed 1 cup, cooked 3

Garlic, dried 1 teaspoon 3

Basil, dried 1 tablespoon 2

Orange juice 1 cup 2

Whole wheat bread 2 slices 2

Red wine 5 ounces 1–13

Apple, with skin 1 medium 1

Banana 1 medium 1

Green beans ½ cup, cooked 1

Source: National Institutes of Health, http://ods.od.nih.gov/factsheets/Chromium_pf.asp#h2,

accessed April 10, 2017.

While you are making sure to include chromium-rich foods in your menu, it

may also help to steer clear of sugar and refined grain products such as white

flour. These foods are not only low in chromium, they also increase chromium

loss from the body. Loss of the mineral is also increased by the stresses of

infection, strenuous exercise, and pregnancy.

Some researchers have gone beyond foods and have tested the effects of

supplements. However, studies in which researchers gave chromium to people

with type 1, type 2, or gestational diabetes have yielded mixed results. The

problem may be that some studies were small and used rather small chromium

doses, but some studies using higher doses in individuals with type 2 diabetes

have shown no benefit.

5

As a result, most diabetes authorities do not recommend

chromium supplements.

If you are going to supplement, you should be aware that the safety of high

chromium doses has not been as extensively studied as that of other minerals.

Studies using chromium for diabetes treatment often exceed the amounts

recommended by the US government, using doses of up to 1,000 micrograms per

day. Individuals with impaired liver or kidney function may be at risk for

adverse effects and should probably stay well below this level. The long-term

benefits and risks of chromium supplementation are not known.

Alpha-lipoic acid. Alpha-lipoic acid, sometimes called thioctic acid, is

naturally produced in the human body. It plays important roles in the

mitochondria, the microscopic “burners” that provide energy in the cells. It

works as a cofactor for several enzymes related to energy metabolism.

Supplemental alpha-lipoic acid is used not to counteract deficiencies but to

act essentially like a drug. In high doses, it acts as an antioxidant. In people with

type 2 diabetes, it appears to increase insulin sensitivity and reduce symptoms of

nerve damage.

6, 7

In many studies of alpha-lipoic acid, researchers used intravenous infusions

rather than oral doses. So far, it appears to be safe, but it is not yet clear whether

it will yield clinically important effects over the long run and if so, what doses

are safe and effective for long-term use.

For Further Reference

If you search for information about supplements on the Web, you may find

yourself carried away by a flood of commercial sites. I recommend this National

Institutes of Health site, cc.nih.gov/ccc/supplements.

CHAPTER 11

Exercise for the Rest of Us

Yes, exercise is good for you. Physical activity reduces your blood sugar and is

good for your heart. It improves the quality of your sleep and your overall

energy level. When you get into an exercise groove, you really feel great.

For many of us, however, exercise conjures up images of painful workouts

and unrewarding drudgery. Many people have trouble getting into an exercise

routine; it just does not seem to work for them. For every person I hear say

something like this:

“I feel so good when I exercise. I have more energy, my blood sugar

comes way down, and I just feel great. I can’t imagine a day without it.”

…there’s another who feels more like this:

“I really just can’t get into exercise. I know I’d do better if I did, but

every time I join a gym or resolve to start exercising, it just doesn’t last.”

If you are carrying around a lot of extra weight, exercise can be difficult.

Perhaps you are limited by joint pain or heart problems. Maybe your good

intentions just seem to vanish when the time comes to lace up your sneakers. In

this chapter, we will tackle the various aspects of exercise—its benefits, its

limitations, and the difficulties in getting started—and see how to make it work

for you.

One note of reassurance: If you cannot exercise because of a physical

limitation, you can still lose weight, cut your blood sugar, and live a healthy life.

In fact, most of the benefits of the diet changes you have read about came

without exercise. That is because in our diet studies, we usually ask our

volunteers not to alter their exercise patterns, so we can isolate the effects of a

diet change for research purposes. Exercise certainly adds to the health benefits

that a good diet brings, but if it is simply not in the picture, you can still do well.

WHAT YOU ARE WORKING FOR

Different kinds of exercise provide very different benefits.

Aerobic exercise is any sort of rhythmic, continuous activity you perform

for a sustained period—usually at least 10 minutes. Brisk walking, running,

playing tennis, dancing, or skating can all be aerobic. This type of exercise

reduces your blood sugar and triglycerides, and if you keep it up, you will live

longer.

Resistance exercise is weight lifting and other exercises in which the

emphasis is on muscular effort: pushups and deep knee bends, for example. It

builds your muscle mass or at least preserves the muscle you have. It also

improves insulin sensitivity.

Flexibility exercises (stretching) are intended to maintain the range of

motion of your joints. They can also relieve stress.

Below, I will give you guidelines for how much and how often you should

exercise.

A diet–exercise combination can help prevent diabetes from ever developing.

A groundbreaking study called the Diabetes Prevention program followed 3,234

people whose blood sugar levels were creeping upward but were not yet high

enough to warrant a diagnosis of diabetes. With a combination of diet and

exercise, the participants were able to cut the risk of developing the disease by

58 percent. The exercise regimen totaled 150 minutes per week—a half hour five

times a week.

1

There is a very big caveat with all of this, though: Exercise can boost the

effects of a healthy diet, but it cannot make up for a poor one. In fact, of the two

components—diet and exercise—the diet portion is much more important for

weight loss and ultimately for preventing or controlling diabetes.

A careful review of published research showed that people who begin

exercise programs do not lose much more weight than people who remain

sedentary.

2

For weight control, exercise cannot take the place of diet changes.

This does not mean that exercise is of no help at all. It is definitely helpful

for reducing A1C. In a review of several studies testing the effect of exercise, the

average A1C in volunteers who began exercise programs fell to 7.7 percent,

which is better than the 8.3 percent found in those who did not exercise.

3

Once

again, however, that result pales in comparison to the benefits of a diet change.

To prevent diabetes or bring it under control, it is best to use both diet and

exercise.

one part of your body that benefits tremendously from exercise is your heart.

A recent study tracked physical activity levels in adults with type 2 diabetes over

a period of 19 years and looked specifically at the risk of dying of heart disease.

It turned out that those who were moderately physically active were about 40

percent less likely to succumb to heart disease than were sedentary people. Their

routines included at least 4 hours per week of moderate exercise such as

walking, cycling, or light gardening.

4

Active people also cut their risk of stroke.

5

There are three other exercise benefits worth noting. First, exercise and

eating are mutually exclusive activities. It is easy to scarf down extra calories

while watching your favorite crime drama or a movie, but it is a real challenge

while you are playing tennis. Exercise is calorie-free fun.

Second, exercise helps you sleep. If you have given your muscles a good

workout, they demand sleep. You will sleep much more soundly than if you had

spent the entire day behind your desk, watching television, or reading. And when

you are well rested, it is easier to stay focused on a healthy diet and say no to

unhealthful foods.

Third, exercise makes you feel better. It lifts your spirits and is a natural

antidepressant.

TYPE I AND TYPE II MUSCLE CELLS

Why do some people love exercise and others loathe it? Surprisingly enough,

part of the reason is genetic. If you could look inside your muscles and compare

them with those of other people, you would discover a sobering fact: Some

people were born to exercise. That is to say, their muscles naturally contain

many type I cells (the name has nothing to do with type 1 diabetes; it is just a

coincidence). These muscle cells have a particularly strong blood supply made

possible by a rich network of capillaries that bring in oxygen and reduce fatigue.

They also have an extra supply of an enzyme called lipoprotein lipase, which

breaks fats apart to be used as fuel. The result is extra energy for a long run.

When you see people running down the road looking invigorated rather than

haggard, or when someone waxes poetic about the joys of the runner’s high, do

not envy their resolve. Odds are, they were born with muscles that are just

loaded with type I cells.

Other people’s muscles contain mostly type II cells, which are fine for short

bursts of exercise but have less endurance for the long haul.

Now, having said that, it is important to realize that muscles can change, at

least to a degree. If you gradually but steadily increase the intensity of your

workouts (within the limits of safety), the blood supply to type II cells increases.

Eventually, they become almost as vigorous as type I cells.

I raise this biological distinction to make an important point: Exercise

aptitude—or lack of it—is not a question of character; it is biology at work. If

you have been beating yourself up for your lack of athletic prowess, it is time for

a reprieve.

MAKING IT WORK FOR YOU

There are two keys to making exercise work.

First, let’s keep it fun. For most of us, that means it should be a social event.

It is more fun to go walking with someone else than by yourself. If you plan to

exercise at a gym, you are much more likely to follow through if you sign up for

a class—aerobics, yoga, or whatever—than if you go it alone. You are also much

more likely to actually get to your class if someone is going with you.

You might make an occasion of it and plan an especially healthful meal

afterward. If you are going dancing or playing tennis, the word exercise may not

even enter your mind. Your activity is too enjoyable to call it that. Keep it fun

because otherwise, you will not do it twice, much less three times a week. And

for most people, fun means friends. You need other people with you to make it

work.

Second, it is important to exercise regularly rather than intermittently. To

paraphrase Newton’s first law of motion, “an object at rest tends to stay at rest,

and an object in motion tends to stay in motion.” If the object at rest is you—that

is, if you are firmly planted on the couch—you will tend to stay at rest. If, on the

other hand, you and a friend go for a walk every other day after dinner, you will

stay on track.

One important tip: As you get ready for an exercise session, you will have

some misgivings. The little devil on your shoulder will tell you that you are too

tired, you don’t have time, you just don’t feel like it, etc. But the fact is, you will

never feel like it right at that “getting ready” moment. So don’t wait for that

perfect day when you will “feel like it.” Just do it anyway, and do it now. Get on

out there and do your thing. And very soon, you’ll discover that you are glad you

did.

This cycle will repeat itself every time you exercise—feelings of misgivings

and negative thoughts, followed by your resolve to just ignore that negativity

and do it anyway, followed by being so glad that you did. And before long, your

confidence will grow and you’ll get into a groove.

There is another reason for keeping exercise regular: The effect of any single

exercise session is small. If you belong to a gym, you can see this for yourself.

Just jump on the nearest treadmill and run flat out for a mile. Then, as you catch

your breath, push the little button that lets you see how many calories you have

burned. Surprised? That’s right, you have expended only about 100 calories.

That’s less than half the calories in an order of McDonald’s french fries or a

bottle of soda. A single exercise session every now and then will not help you

any more than occasionally eating a healthy meal. To be really effective, healthy

habits have to be part of your routine.

Also, for better or worse, exercise effects do not last very long. If you are

laid up with an injury, for example, you will find your blood sugar or weight

gradually returning to its pre-exercise level. People who get into a habit of going

for a brisk walk or bicycle ride every day or two sustain their benefits.

Bottom line: To make exercise work, keep it fun, and keep it regular.

SEE YOUR DOCTOR FIRST

Before you embark on a new exercise program, be sure to get your doctor’s

okay. Is your heart up to it? Are your joints ready? How vulnerable are you to

hypo- or hyperglycemia? Do you have any special eye or foot problems that

could be aggravated by exercise? Your doctor should address all of these

questions.

Beware of jumping into vigorous exercise too quickly. If it has been months

(or years) since you tried exercising regularly, start slowly. It takes time for your

body to reap the rewards of your new, improved diet. A heart patient, for

example, who begins a vegan diet, stops smoking, and starts really taking care of

himself will probably feel better very soon. His chest pain may melt away within

a few weeks, and he will be eager to jump into a vigorous exercise program. The

fact is, though, that he still has the artery blockages he has been accumulating for

years. Yes, the damage can be reversed, but it takes time, and he should not push

himself past the limits set by his doctor.

If you have type 1 diabetes, you may find that your blood sugar drops

precipitously during and after exercise. This can also happen to people with type

2 diabetes who use insulin or drugs that cause insulin secretion (e.g., glyburide,

glipizide, glimepiride, nateglinide, or repaglinide). It is important to be alert to

the possibility of a major blood sugar drop and to adjust your eating schedule,

medication use, and exercise accordingly.

Occasionally, the opposite can occur: You may find that your blood sugar is

temporarily higher after exercise than it was before.

A research team based in Florida tracked blood glucose in children with type

1 diabetes as they walked on a treadmill in four 15-minute bouts, with 5-minute

rest periods in between. Their average blood glucose was 159 mg/dl when they

started, and it fell to 112 mg/dl afterward. At least one-quarter of the children

became hypoglycemic during or right after the exercise. They were also more

likely to be hypoglycemic during the following night.

6

Exercise can reduce your blood sugar surprisingly quickly. Of course, if you

eat too much in an effort to prevent hypoglycemia, your blood sugar can go too

high.

For these reasons, it is important to speak with your caregiver about your

medication, diet, and exercise program to make sure you are ready for exercise,

then make whatever adjustments are needed for safety.

GETTING STARTED

Okay. Your doctor has given you the green light, you have rustled up some

friends, and you are ready to begin.

If you were imagining that I would push you into hours of jogging and

weight lifting and harangue you with exhortations about “no pain, no gain”—

well, push those thoughts aside. The goal is to enjoy exercise—so much so that it

becomes part of your life.

For aerobic exercise, I suggest starting with a half-hour brisk walk 5 days a

week, assuming that you have no health-related exercise restrictions. If you

prefer, you can exercise three times per week, either taking brisk 1-hour walks or

doing more vigorous half-hour workouts. You can also break up those 30-minute

walks into 10- or 15-minute mini-workouts if you like. Do not allow yourself

more than 2 sedentary days in a row. The benefits of walking are not as great as

those of a more vigorous exercise program, but it is a good place to start.

The important thing is to find a time that works for you.

It is a good idea to put exercise on your schedule, as if it were an

appointment with yourself, and to include someone else in your plans.

A pedometer will help you keep track of your progress. In our research

studies, we use an Omron pedometer to track the total number of steps

participants take each day as well as the number of “aerobic steps” (steps taken

as part of a continuous walk of at least 10 minutes). The participants can also

program in their stride length to track mileage and even estimate their calorie

burn. Take note of how many (or how few!) steps you take in a normal day, then

gradually increase them. For reference, 10,000 steps or more is a vigorous day

for a healthy person, but you may not have the strength or stamina to do that

many. Do not push beyond your doctor’s recommended limits.

A podiatrist or nurse specializing in diabetes (certified diabetes educator, or

CDE) will help you take care of your feet. This is important since exercise can

sometimes cause foot injuries or aggravate an existing injury. It is surprising how

often people are unaware of gradually worsening foot sores.

Your doctor will help you gauge your improvement and can advise you about

increasing your exercise intensity. As your endurance improves, you will find

that your energy just keeps increasing, and your weight and blood sugar stay

under better control.

What’s Your Pleasure?

Taking a regular walk is a great way to start exercising. When you are ready to

add other activities, think about which ones you might enjoy.

• Aerobics classes can be fun, social, and sometimes intense.

• Dancing is wonderful exercise, with better music than most aerobics classes.

• Tennis, either singles or doubles, can be a great workout.

• Many health clubs organize racquetball or handball lessons and

competitions.

• Golf can be great exercise if you walk the course.

• Local running clubs often organize training groups for people working

toward 5-K, 10-K, and half- and full-marathon races.

For resistance and flexibility exercises, I suggest that you work with a

personal trainer, both for safety reasons and to individualize your program using

the right equipment. Professional athletes are not the only ones with access to

professional fitness expertise; you can have it, too. A personal trainer can help

you plan a full program, not only for aerobics but also for strength training and

flexibility.

most health clubs have trainers on staff and may even offer a free session as

an incentive to join. Why not take advantage of it? If you do not plan on joining

a gym, just make an appointment for a single exercise counseling session so you

can get a program that is right for you. Then schedule a follow-up.

No Blame, No Shame

With exercise, just as with diet, most people are not yet where they would like to

be. Guilt and blame come into the picture when we are sedentary, just as they do

when we are not eating well. Sometimes family members try to scold us into

exercising, and sometimes doctors try the same approach. But all their

moralizing is nothing compared to the guilt-laden punishment we heap on

ourselves, as if not exercising were a tremendous moral failing.

If that is where you are, let me encourage you to set guilt and blame aside.

Just let it all go. Tell your guilt-inducing friends that up until now, you have been

illustrating Newton’s first law of motion. Now, however, you are about to get

into gear and explore the second part of that principle.

The same applies if you happen to fall off the wagon. Let’s say you have let

your exercise regimen lapse for a bit—maybe even a very long bit. Do not waste

your time feeling bad about it; it happens to everybody. Just dust yourself off and

get back on.

When exercise is fun and your friends or family are part of it—and when you

start at a level that’s right for you and keep it regular—you have the formula for

success.

PART 3

Complete Health

CHAPTER 12

A Healthy Heart

Managing or reversing the effects of diabetes means more than getting your

blood sugar under control. It also means regaining your health as much as you

possibly can, and safeguarding it.

If you have been in poor health—or if diabetes has attacked your heart, eyes,

kidneys, and nerves—revamping your diet can have a dramatic positive effect on

your well-being. In this chapter and the next, we will look at how to keep your

heart—and the rest of you—healthy.

TAKING RISK SERIOUSLY

You probably already have a good idea of your risk of heart problems. Your

doctor has sized up your cholesterol level and blood pressure, and you know

your family history. You may be on medications to control cholesterol or

strengthen your heart.

The next step is to review what you need to know about risks, and more

important, to see what you can do to prevent heart disease and, if necessary,

reverse the disease process.

In evaluating your risk of developing heart problems, doctors look at your

age, family history, smoking habits, weight, cholesterol level, blood pressure,

and other factors. I believe, however, that it is prudent to act as if you are at risk

even if none of these factors apply to you. Here is why: Most people in North

America and Europe have already developed artery blockages—the beginnings

of heart disease—by the time they reach early adulthood. Having diabetes

increases that risk. Rather than wondering, “Am I at risk?” it is safe to simply

assume that you are—and to take action to protect yourself.

Some evidence suggests that your heart is assaulted especially hard by

smoking, high blood pressure, and high cholesterol levels, while your small

blood vessels, such as those in your eyes and kidneys, are especially sensitive to

high blood glucose levels. That is probably true, although all of these risk factors

matter for both types of complications.

SIZING UP THE ENEMY

let’s take a minute to understand the dragons we are slaying, starting with

cholesterol.

Your body uses cholesterol in the same way a factory might use petroleum.

Cholesterol is a raw material, and your body makes many things from it. Believe

it or not, cholesterol is used to make certain hormones, including testosterone

and estrogen. It is also inserted into the thin cell membranes that surround each

cell in your body, and it acts as a kind of glue to hold the membranes together.

Without it, you would collapse into a gelatinous heap.

Just as refineries send trucks filled with petroleum to factories to be turned

into everything from plastic to petroleum jelly, your liver sends particles

containing cholesterol into your bloodstream for your cells to use.

Imagine what would happen if a refinery flooded the roads with tankers,

sending out far more supply than was needed. Day after day, more and more oil

trucks would clog up the roadways. Some might have accidents, spilling cargo

and creating havoc.

Cholesterol presents the same problem. When too many particles of

cholesterol pass through your bloodstream, they create a different kind of

congestion.

The circulating particles can easily become damaged. When they do, they

spark the formation of raised bumps called plaques, which are very much like

small scars on your artery walls.

Now, this is dangerous, because plaques are fragile. They can crack or

rupture, and when that happens, the blood around the plaque starts to clot. The

growing clot can fill the artery like a cork and stop blood-flow. If that happens in

an artery that carries blood to the heart, a portion of heart muscle will die. That’s

a heart attack, which doctors call a myocardial infarction.

The solution to the problem is to reduce the number of cholesterol particles

circulating in the bloodstream. Luckily, we know how to do that. Although

previous diets had only a modest ability to lower cholesterol, the diet changes

described within the pages of this book are dramatically effective.

Is It My Genes?

Rick was 45 when he came to our office looking for help. He was not terribly optimistic that a

diet change could really help him. His father had had diabetes and heart disease, and his own

cholesterol had been high for years. Previous diets had let him down. A few years earlier, his

doctor had suggested limiting red meat and eating more fish and chicken, but the change had

had no perceptible effect. “I must have a genetic problem,” he said.

It may well be that genes played a big role in his problem, I told him. But we would not know

that until we made a more serious effort to change his eating habits—one that went beyond

what he had tried before.

I explained to him what you are reading in this chapter. He decided to give it a try. (His story

continues in the box “Jumping Into Oatmeal.”)

REVERSING HEART DISEASE

The most famous program using diet and lifestyle changes to tackle cholesterol

and reverse heart disease was developed by Dean ornish, MD, at the Preventive

Medicine Research Institute in Sausalito, California.

Dr. Ornish is a Harvard-trained physician who made medical history in 1990

by showing that a combination of diet and other lifestyle changes could actually

reverse artery blockages. His findings were published in the Journal of the

American Medical Association, Lancet, and other prestigious journals.

In his landmark study, Dr. Ornish recruited heart patients from hospitals in

the San Francisco area and divided them into two groups. Participants in one

group—the control group—were asked to follow their regular doctors’ advice

about diet and other treatments. Generally speaking, that meant a diet favoring

chicken and fish rather than red meat, cutting back on fat, and using medications

as needed.

The other group—the experimental group—was given a very different

regimen. They did not use cholesterol-lowering drugs at all. Instead, they began

a very special diet. First, because cholesterol is found in animal products (meat,

dairy products, and eggs), Dr. Ornish chose a vegetarian diet for the study.

Remember, grains, beans, vegetables, fruits—in fact, all plant-derived foods—

are essentially cholesterol-free.

These foods are also free of animal fat, which is even more important. Just to

clarify, cholesterol and fat are two different things. Cholesterol is a microscopic

ingredient in cell membranes, as described above, and is present in all animal

cells.

Fat is different. It is the white strip in a cut of roast beef, the yellow layer

under chicken skin, and the greasy residue left on your fingers if you touch a

salmon fillet. You can easily see and feel animal fat. When you eat it, your body

makes cholesterol.

I learned about animal fat as a child growing up in North Dakota. Some

mornings, my mother cooked bacon for my four siblings and me. When it was

done, she put the hot strips on paper towels to drain. She then carefully picked

up the frying pan and poured the hot grease into a jar to save it. Now, she did not

store the jar of bacon grease in the refrigerator; she simply put it in the cupboard.

She knew that as it cooled, it would turn into a waxy solid. The next day, she

spooned some of the bacon grease into a pan and fried eggs in it. With that sort

of diet, it is perhaps remarkable that any of her children lived to adulthood, but

that is the way we ate until we learned better.

The fact that bacon grease is solid at room temperature is a sign that it is

loaded with saturated fat, which you can think of as “bad” fat, because it raises

your cholesterol level.

*

All fats are mixtures. Beef fat, for example, is about half saturated fat, with

the rest being a mixture of various unsaturated fats. Chicken fat is about 30

percent saturated fat. Fish vary from about 15 to 30 percent saturated fat.

Vegetable oils are much lower in saturated fat, except for the tropical oils:

Coconut, palm, and palm kernel oil are all high in saturated fat.

Some food companies alter vegetable oils through a process called

hydrogenation, which makes them similar to saturated fats. The resulting fats,

called trans fats or partially hydrogenated fats, are solid and have a long shelf

life. Unfortunately, their effect on your cholesterol level is similar to that of

butter or lard. They are sometimes used in restaurant fryers and in snack foods.

When you see the words partially hydrogenated vegetable oil on a food label,

it’s a good idea to move along to a healthier choice.

You can see why Dr. Ornish decided to use a vegetarian diet in a program of

healthy lifestyle changes. Plant foods have essentially no cholesterol and no

animal fat. He also kept vegetable oils to a minimum.

The results were remarkable. Among the vegetarians, chest pain rapidly

melted away. The average person’s LDL (“bad”) cholesterol fell by about 40

percent. After a year, each participant had an angiogram—a special x-ray that

shows blockages in the arteries of the heart—and Dr. Ornish compared the

results with those of the same kind of test done at the beginning of the study. The

results were amazing: The blockages in the coronary arteries—the arteries that

nourish the heart muscle itself—were actually starting to shrink. The arteries

were opening again. The effect was so pronounced that the difference could be

clearly seen on the angiograms of 82 percent of patients after the first year—all

with no heart bypasses, no angioplasties, and not even cholesterol-lowering

drugs.

WAKE UP AND SMELL THE CHOLESTEROL

By now you are probably yawning, saying you already know that cholesterol and

saturated fat are bad and that we’re supposed to cut down on them. “Been there,

done that,” you say.

Well, that is exactly the problem. For years, health authorities have suggested

that people “cut down” on foods containing cholesterol and animal fat. Many

people have chosen “leaner” cuts of beef and favored chicken and fish, but they

have gotten very little in the way of results. Most people find that despite these

diet changes, their cholesterol levels barely budge at all, and many have decided

that diet changes are a waste of time. They conclude that their problems are

genetic and give up on their diets.

It turns out that a switch from red meat to white meat is just not good

enough. And here’s why: All meats—even “lean” meats—contain cholesterol,

ranging from about 10 milligrams in every ounce of tuna to about 50 milligrams

per ounce of shrimp. Chicken and beef are in between, with about 25 milligrams

per ounce. And yes, cholesterol in foods does pass into your bloodstream.

Despite the egg industry’s efforts to convince scientists and the public that

“cholesterol in foods does not affect how much cholesterol is in your blood,” the

fact is that cholesterol in foods does indeed raise blood cholesterol. Red meat,

poultry, and fish—even the “leaner” cuts—also contain a significant amount of

fat. And saturated fat causes your body to make cholesterol.

In contrast, of course, there is no cholesterol or animal fat in any food from

plants. That goes for every fruit and vegetable; every bean; every grain; every

variety of rice, pasta, and potato; and everything made from them.

Thus, if you were to try to lower your cholesterol by simply switching from

beef to chicken and fish, you would have one arm tied behind your back. As

shown in clinical tests, the cholesterol-lowering effect of a switch from red meat

to white meat is minimal—only about half the effect of a plant-based diet. Most

people who follow such diets have no measurable improvement within their

arteries, either—on average, their artery blockages continue to get worse as time

goes by.

WHY DIDN’T ANYONE TELL ME?

When Dr. Ornish’s findings were published, most medical authorities were

willing to believe his program was a very healthful regimen. But many felt the

program was so austere that few people could actually follow it. I have studied

that issue in some detail, however, and have come to a completely different

conclusion. The diet is not terribly austere. In fact, it stacks up well against any

other diet a doctor might prescribe. Let me describe my own experience.

When I was growing up in cattle country, my family ate pretty much the

same things every day: roast beef, baked potatoes, and corn—except for special

occasions, when we ate roast beef, baked potatoes, and peas.

In medical school, I decided to change my diet. At first, I tried pasta, making

a sauce from fresh tomatoes, basil, and spices. Then I discovered that just below

the beef, poultry, and fish choices, Chinese restaurant menus feature many

delicious vegetable dishes, as do Mexican restaurants. Japanese restaurants serve

delicious miso soup, salads, and vegetable sushi. Middle Eastern cuisine is

simple but delicious, with hummus, falafel, couscous, and other delights. Thai,

Indian, Ethiopian—all these cuisines offer endless vegetarian choices. Compared

to those elegant meals, my North Dakota roast beef, baked potato, and corn no

longer seemed like the pinnacle of the culinary art. To me, a plant-based diet was

a world of new tastes and was anything but austere.

When I first learned about the work of Dr. Ornish in the late 1980s, I was

working at the psychiatry clinic at George Washington University. I telephoned

him and suggested that we study the acceptability of his diet. I flew to San

Francisco and interviewed each of the participants in his heart study.

1

I asked

how well they liked the foods they ate, how much effort was required to prepare

them, what their family members thought, and what they planned to do in the

future.

I found that the vegetarian group did grumble a bit at first. They had to learn

about some new foods and master some new cooking tricks. On average, it took

about 4 weeks before the diet really became second nature to them. But they

adapted well, partly because they saw such dramatic results. Their cholesterol

levels plummeted, their chest pain disappeared, and their heart disease reversed.

The average participant lost, believe it or not, 22 pounds during the first year.

2, 3

They came to love the foods they ate.

I vividly remember one participant’s reaction. He was angry—angry that

previous doctors were eager to prescribe potentially dangerous drugs and even

operate on him, charging him enormous amounts of money, and did not bother to

even mention the power of diet changes. Overall, the participants not only found

their diets acceptable, they felt it would be wrong for doctors not to give patients

this kind of choice.

Now, it did not surprise me that the vegetarian diet took a little getting used

to, or that the patients soon came to love it. What surprised me was the reaction

of the control group—the group that was not asked to adopt the vegetarian diet.

They grumbled, too. Some said their diet was nothing but chicken and fish,

chicken and fish, chicken and fish, night after night. All the pleasures of life

were gone, some said. And they had nothing to show for it. Many were still

dealing with chest pain, trying to control their cholesterol levels with

medication, and fighting a losing battle.

Having repeatedly studied how people react to different diets, I am

convinced that a vegan diet is actually easier to follow than most other diets.

This is partly because of its simplicity. Like quitting smoking or freeing yourself

from any other habit, setting aside unhealthy foods is easier than teasing yourself

with small amounts of them day after day. And the diet’s benefits are usually so

rewarding that you want to stick with it.

A few years later, I reviewed every published research study in which heart

patients were asked to change their diet, with researchers tracking their success

or failure.

4

At the time, the prevailing wisdom was that doctors should not push

their patients too hard to make diet changes because the patients were likely to

just throw up their hands and give up. But I found just the opposite. In controlled

studies, when researchers asked patients to make small diet changes, they in fact

achieved only small changes. When researchers encouraged their study

participants to make bigger diet changes, most participants actually did make

them, and they got better results. You can do it, too. Your heart deserves the very

best.

AIMING TO BE HEART ATTACK–PROOF

let’s leave Dr. Ornish’s California research center and take a short trip to Ohio to

meet Anthony Yen. He grew up in China, where his family members routinely

lived to a ripe old age. For them, heart disease, weight problems, diabetes,

cancer, and high blood pressure were virtually unheard of. They dined on rice,

noodles, and vegetable dishes of various kinds and used meat as no more than a

flavoring, the way some might use bits of onion, garlic, or pine nuts.

In 1949, as a young man, Anthony moved to the United States and slowly

gave up his traditional Chinese diet in favor of an American one. As the years

went by, he gradually gained weight, like many of his American friends, and he

started to develop heart problems, which steadily worsened. Ultimately, he

needed surgery—a quintuple heart bypass.

Then he was lucky enough to join a program for heart patients run by a

surgeon at the Cleveland Clinic. Caldwell Esselstyn Jr., MD, aimed to get

cholesterol levels so low that heart disease would stop in its tracks. He

prescribed a vegetarian diet without dairy products or added oils. He showed

patients how to cook and even occasionally hosted group dinners that featured

home-cooked foods. He added medications only if a patient’s cholesterol level

did not fall below 150 mg/dl with diet alone.

The program worked. Dr. Esselstyn’s patients became practically bulletproof.

Although they were in bad shape when they arrived, no one who adhered to the

program had any sort of recurring heart problem.

5

Anthony’s cholesterol level

improved dramatically. He lost weight and felt better than he had in years.

In the ensuing years, Dr. Esselstyn called American cardiologists together for

the Summit on Cholesterol and Coronary Disease. He put forward his belief that

physicians need to promote healthier diets. If doctors continue to prescribe only

modestly effective diets, he said, their patients will be stuck with endless

prescriptions, operating rooms will remain busy with angioplasties and coronary

bypass surgeries, and medical costs will continue to soar.

Dr. Esselstyn was right, as Anthony Yen, his other patients, and a growing

number of physicians can attest.

SPECIAL-EFFECT FOODS

By now, you know which foods to avoid. By skipping animal products and

added oils, you will sidestep cholesterol and the fat that can drive cholesterol

levels up. Of course, you want to avoid these foods anyway in order to improve

diabetes.

There are foods you might want to add to your diet, though, because they can

actually lower your cholesterol or protect against the damage that cholesterol can

cause.

• Oats, beans, and barley contain soluble fiber that reduces cholesterol

levels. You have no doubt heard that oatmeal and other oat cereals have this

effect, and they have become popular for exactly that reason. But do not

forget the cholesterol-lowering power of the humble bean, which also

contains soluble fiber. Eating a serving of beans every day cuts cholesterol

levels significantly. Soluble fiber is also found in many vegetables and fruits.

• Soy products have a special cholesterol-lowering effect. Aside from the fact

that they have no cholesterol or animal fat, there is something about soy

protein that brings down cholesterol a bit further. If your burger is made of

soybeans instead of beef, you will not only skip beef’s cholesterol and fat,

you will also get an extra cholesterol-lowering benefit.

6

• Certain nuts, such as almonds and walnuts, lower cholesterol, too. Yes,

they are as high in fat as other nuts, but somehow they have an ability to

reduce cholesterol levels that has not been fully explained. In studies, eating

3 ounces a day for 4 weeks has shown a measurable effect.

7

I do not

recommend that you make nuts a regular part of your diet, however. Despite

their cholesterol-lowering effect, they are so fatty that they will make weight

loss difficult and may interfere with your efforts to improve insulin

sensitivity.

• Some margarines incorporate natural plant stanols or sterols that work

almost like drugs, blocking the absorption of cholesterol from the small

intestine. Benecol Light spread, for example, contains plant stanols derived

from pine trees mixed into a spread made with canola and soybean oils (see

benecol.com). You can use it in baking and frying if you like. It is not a low-

calorie or low-fat spread, though; 1 tablespoon has about 50 calories. Like

nuts, margarines can interfere with your weight-loss efforts.

• Fruits and vegetables are not only cholesterol free and very low in fat; their

beta-carotene, vitamin C, and vitamin E can actually reduce the damaging

effects of cholesterol in your blood. Here’s why.

As cholesterol particles glide along in your bloodstream, those that enter

artery walls and cause plaque buildup are the ones that have become slightly

damaged, or oxidized. Beta-carotene, vitamin c, and vitamin E actually

protect the cholesterol particles from damage so they go on their merry way

without harming you.

You will find huge amounts of beta-carotene in orange vegetables, such

as carrots, sweet potatoes, and pumpkins, but there is also plenty in green

leafy vegetables. Vitamin C is in citrus fruits, of course, but also in many

other fruits and vegetables. And whole grains, vegetables, and beans are

healthful sources of vitamin E.

At the University of Toronto, Dr. David Jenkins took this approach to its

ultimate conclusion. He reasoned that if a vegan diet (that is, one with no meat,

dairy products, or eggs) lowers cholesterol levels; if soluble fiber, such as that in

oat bran, lowers cholesterol; if certain nuts lower cholesterol; if soy products

lower cholesterol; and if plant sterols lower cholesterol, then what would happen

if he prescribed them all at the same time?

He devised what he called a portfolio Diet, which included all of these

elements, and found that the combination led to a 29.6 percent drop in LDL

cholesterol in just 4 weeks, which was similar to the effect of cholesterol-

lowering drugs.

8

CONTROLLING CHOLESTEROL STEP BY STEP

Let’s summarize what research tells us about the ideal cholesterol-lowering diet.

Here are the keys.

1. Skip animal products. You will want to avoid meat (that means no red

meat, no chicken, and no fish), dairy products, and eggs. Avoid them entirely,

and you will eliminate all the animal fat and cholesterol from your diet. You

already know this is important for diabetes, and it is just as important for your

heart.

2. Keep vegetable oils to a minimum. To trim the oil from your diet, skip

the oily dressings, fried foods, and foods prepared with extra oil. Read the labels

on packaged foods. If you spot animal products or partially hydrogenated oils in

the ingredient list, you will want to avoid that food. And if there are more than 2

to 3 grams of fat in a serving, skip it.

3. Add special-effect foods. The best of these are oats, beans, and soy

products. They are filling but modest in calories, and they really do bring your

cholesterol down. It is easy to add special-effect foods to your routine.

Oats: Start your day with a bowl of old-fashioned oatmeal. Top it with

cinnamon if you like, but skip the milk and sugar or use soy milk.

Beans: Like oats, beans are high in soluble fiber, which lowers cholesterol.

Baked beans, black beans with salsa, pinto beans wrapped in a tortilla—all

are loaded with soluble fiber, protein, and all-around good nutrition. The

humble bean has even become quite chic, with some growers specializing in

beautifully colorful heirloom varieties.

Soy: It is easy to bring soy milk into your routine. You will also want to

learn about the many other forms of soy: low-fat tofu, tempeh, and many

others. Some people are a bit tentative about tofu until they taste it properly

prepared, then they come to love it. For all soy products, read the labels and

choose those lowest in fat.

With these changes, most people can expect to see major results. Diets that

eliminate cholesterol and animal fat (vegan diets), keep oils low, and use special-

effect foods typically achieve a big reduction in “bad” cholesterol.

4. If you are overweight, follow the weight-loss guidelines described in

Chapter 6. Each pound you lose cuts your total cholesterol slightly.

9

The effect is

gradual but important.

5. Exercise. When your doctor gives you the green light to exercise, you will

find it enormously helpful. Exercise will not lower your total cholesterol, but it

will increase HDL cholesterol, and that may improve your overall health profile.

Regular exercise (taking a brisk 30-minute walk five times a week or a 1-hour

walk three times a week) also helps keep your blood pressure under control.

Work with your doctor to set exercise goals based on your current health (see

Chapter 11).

Jumping Into Oatmeal

Rick, whom you met earlier, did very well with his diet changes despite his initial reservations.

He learned how to make a quick and hearty vegetable soup from a dried soup mix to which he

added tomatoes, cucumbers, sweet potatoes, and whatever other vegetables he had on hand.

He often cooked pasta and usually used marinara sauce from a jar for convenience. He also

included plenty of salads and cooked vegetables. Eating out was a challenge for him until he

discovered that international (Italian, Chinese, Japanese, Mexican, Thai, etc.) restaurants had

plenty of options. Speaking up helped, too—most restaurants gladly made him a vegetable

plate when he asked for it. He figured out which fast-food restaurants had veggie burgers or

salad bars and where he could get a respectable bean burrito.

He took a shine to what he called fake meats—bologna, ham, and other deli slices made of

soy protein—which he used in sandwiches with sliced tomato, lettuce, and Dijon mustard.

Sometimes he had a simple meal of beans and rice or a packaged rice dish (curried rice, rice

pilaf, etc.). He also became quite fond of couscous. For breakfast, he jumped into oatmeal,

figuratively speaking, and kept bananas and other fruits on hand both at home and at work.

While he found the diet surprisingly easy, he ran into a stumbling block at the beginning. He

served himself modest portions and resisted going back for seconds. As a result, he often felt

hungry. The fix: He simply ate more. On another occasion, he took my advice to eat beans a bit

too far and had an episode of gastric distress. He cut back on his bean serving sizes for a bit

and was fine.

His wife joined him in adopting a vegan diet. In the process, she lost a substantial amount of

weight and had more energy than she had had in years.

By the time Rick came in for his follow-up blood test, he had totally adapted to the diet, and

he was thrilled with the results. In 3 months, his cholesterol had dropped from 210 to 145, with

an LDL of well below 100. And this was the same man who had started out saying what he

really needed was different genes. “You know, this isn’t a diet,” he said. “This is a way of living,

and it just feels right to me. I’m never going back to the way I used to eat. This is it.”

SIZING UP YOUR PROGRESS

It is easy to see if the program is working. Follow it carefully, and after about 8

weeks, ask your doctor to check your cholesterol level. If you have not quite

reached the goals you set for yourself, take a close look at what you have been

eating. How well have you followed the program? If you really did follow it

carefully and your cholesterol failed to budge, you are probably one of those

uncommon individuals whose genes really are driving up their cholesterol levels.

If diet alone proves insufficient, follow your doctor’s advice, which may

include cholesterol-lowering medications. Some doctors believe that medications

have value even when cholesterol levels are normal. Research is under way to

test this possibility.

WHAT ABOUT “GOOD” CHOLESTEROL?

The cholesterol in high-density lipoprotein (HDL) particles is called “good”

cholesterol for only one reason: It is on the way out of your body. HDL particles

scour your artery walls, picking up cholesterol and eliminating it, like tiny

sanitation trucks carrying away garbage.

When people begin low-fat vegan diets, their HDL levels sometimes fall

slightly. But that is not a reason to worry—your LDL (“bad”) cholesterol level is

likely to fall much more. In fact, some people say that, since you have less

“garbage” in your bloodstream (that is, less LDL cholesterol), you don’t need so

many “garbage trucks” (that is, HDL cholesterol) to haul it away.

REDUCING TRIGLYCERIDES

Triglycerides is a technical term for fat in the bloodstream.

*

lowering

triglycerides is a good idea, as it will reduce your risk of heart problems. It is

usually easy to do. A low-fat plant-based diet is a good start. But take one

additional step: avoid sugar, white bread products, and other high-GI foods, as

discussed in Chapter 4. These foods seem to raise triglycerides, while low-GI

foods that are rich in fiber seem to lower them. You will probably see a big drop

in your triglycerides.

ONE SOLUTION TO MANY PROBLEMS

If you have been following along, you have probably come to this happy

conclusion on your own: You do not need one diet for diabetes, another for

cholesterol control, and a third one for weight loss. A diet that skips animal

products, keeps vegetable oils low, and favors high-fiber, low-GI foods tackles

all these problems at the same time.

Just as a drop in cholesterol is good for your heart, a drop in A1C is, too.

People who keep their glucose under good control have fewer heart problems as

the years go by.

The same diet changes also help control your blood pressure, partly because

they can cause you to lose weight, and as your weight falls, so does your blood

pressure. But the effect of vegetarian diets on blood pressure goes beyond their

effect on weight. Plant-based diets are rich in potassium, which seems to reduce

blood pressure. The absence of animal fat also reduces blood viscosity (that is,

blood is less “thick”—less like grease and more like water) so it flows more

easily through the blood vessels.

10

For many people, the effect of diet changes rivals or exceeds that of

medications. If, for whatever reason, your cholesterol, blood pressure, or blood

sugar does not come under good control despite your best efforts, your doctor

will rightly talk with you about medications to take up where diet leaves off.

*

If you are wondering where the term saturated fat came from, it’s actually very logical. If you could look

at a fat molecule under a powerful microscope, it would look like a long chain of carbon atoms, with

perhaps 18 or 20 atoms joined in a line. Attached to the carbon chain are hydrogen atoms. If the chain is

completely covered (i.e., saturated) with hydrogen atoms, the fat becomes a waxy solid and is called a

saturated fat. If, however, hydrogen atoms are absent at several spots on the fat chain, the fat is called

polyunsaturated. Polyunsaturated oils are liquids. And if just one spot on the carbon chain has no hydrogen

atoms attached, the fat is called monounsaturated. Olive and canola oils are rich in this sort of fat. They are

unusual in that they are liquid at room temperature but solid in the refrigerator. Saturated fat is the kind that

pushes your cholesterol upward.

*

The word triglyceride is derived from the fact that when your body transports fat molecules from one

place to another, it generally attaches three fat molecules to a glycerine molecule (hence, tri-glyceride)

before sending them into the watery environment of the bloodstream.

CHAPTER 13

Healthy Nerves, Eyes, and Kidneys

Selwyn was 58 years old when he heard we were looking for volunteers for a

research study. Originally from Trinidad, he had been diagnosed with diabetes

almost 20 years earlier. The disease had taken a toll on his eyes, and he was

being treated for glaucoma.

He also had terrible nerve pain. In the 18 months before the study began, the

pain in his feet had gotten worse and worse. “It was excruciating,” he said. “It

hurt from the calves down, especially on the left side. And it worsened as the

day wore on. By the time I got home from work, I just had to put my feet up. At

night, the bottoms of my feet hurt terribly, with burning and tingling.”

He had had several medical tests to search for a treatable cause, but his

doctors were left with only diabetes to blame for his misery. Despite the fact that

he used insulin twice a day, his diabetes was not under good control.

He began doing stretching exercises, which seemed to ease the pain

somewhat. When our study began, he started a low-fat, vegan diet. It suited his

tastes and had a remarkable effect on his diabetes. At the beginning of the study,

his A1c was 9.1 percent, but his blood sugar began to fall soon after he made the

switch to our eating plan. Within a month, he began to have episodes of low

blood sugar, so his insulin doses were reduced. Despite the fact that he was

taking less medication, his A1C at the 3-month point was down to 7.7. That was

a big improvement, although he was not yet where he needed to be.

However, he kept improving. And about 6 months into the study, something

remarkable happened. “I noticed a drastic change. I had been in total pain, but

the symptoms started going away,” he said. As time went on, things got better

and better. The pain became barely perceptible, and eventually—to his

amazement—it disappeared altogether. “I’m totally normal,” he said. “I have no

pain at all anymore.”

If a medication could deliver the result he achieved, it would be a very

popular one indeed. “The difference has been like night and day for me,” he said.

A healthful diet does much more than keep your blood sugar down; it helps

protect your whole body. If diabetes rages out of control, it can not only damage

your heart, it can also attack your nerves, your eyes, and your kidneys. The diet

you are now beginning will help you avoid these problems. In this chapter, we

will look at how to keep all your body parts in good working order.

HEALTHY NERVES

People with diabetes are at risk of nerve damage, which can take two forms.

Peripheral neuropathy, sometimes called sensorimotor neuropathy, is

damage to the nerves that allow you to feel things or to move your muscles. It

leads to tingling, pain, numbness, or weakness in your feet or hands. It pays to

take these signs seriously because although it can get better, it can also get a lot

worse if you are not careful.

Reduced sensation in your feet can leave you vulnerable to injuries that you

cannot feel. It is easy to overlook a small cut or scrape when you do not feel it.

Injuries can also be slow to heal, which can set you up for a festering infection.

Diabetes is a common cause of amputation, something that should never happen

with good care.

Autonomic neuropathy is abnormalities in the nerves that control your

internal functions. It can lead to digestive problems, such as nausea, vomiting,

constipation, or diarrhea. It can also cause problems with bladder control or

sexual function. Other symptoms include dizziness, faintness, increased or

decreased sweating, visual difficulties (e.g., problems adjusting to light and dark

conditions), and lack of awareness of the warning signs of low blood sugar.

SEE YOUR DOCTOR

Sometimes nerve symptoms have nothing to do with diabetes. If you have

unexplained numbness, pain, tingling, or other nerve symptoms, it is important

to see your doctor to check for conditions that can be treated. For example, if

you are low in vitamin B

12

, you can have nerve pain that is indistinguishable

from the nerve symptoms of diabetes and can end up being permanent. Your

doctor will check your vitamin B

12

blood level and will help you get back on

track, if that is the issue. Nerves are also affected by thyroid conditions,

medications, infections, compression, and other factors. So it’s important to have

a good evaluation.

If the diagnosis is diabetic neuropathy, the key to preventing and treating it is

to get your diabetes—particularly your blood glucose level—under control,

starting with diet and exercise. If neuropathy has affected you, you will want to

reread Chapter 4 and follow the diet guidelines to the letter, aiming for the best

possible glucose control under the guidance of your doctor. There are

medications that can help slightly, but for most people, diet and exercise are far

more  powerful.
At   California’s   Weimar   Institute   of   Health   and   Education,   Milton   Crane,
MD,   asked   21   diabetes   patients   with   peripheral   neuropathy   to   do   two   things:
begin   a  low-fat,   vegan  diet  and   take  a   daily   30-minute  walk.   The   effects   were
rapid  and  very  strong:  Within  2  weeks,  leg  pains  stopped  completely  in  17  of  the
participants,  and  the  remaining  4  had  partial  relief.
1
My  own  research  team  carried  this  research  a  step  further.  We  invited  people
with   neuropathy   to   see   what   a   diet   change   alone   could   do   for   them—without
exercise.  Not  that   exercise  is  bad.  Just   the  opposite,  it’s  very   healthful,  but  we
wanted   to   isolate   the   effect  of   diet   for   scientific   reasons,   to   see   how   powerful
foods   could   be.   Using   the   diet   steps   that   are   now   familiar   to   you   (avoiding
animal  products,  minimizing  the  use   of  oils,  and  favoring  low-Glycemic-Index
foods),   we   found   that,   for   many   patients   pain   improved   or   simply   went   away,
and  objective  tests  of  nerve  function  improved,  too.
2
Supplements  for  Treating  Neuropathy
Researchers  have   tested  the   effects  of   the  following   supplements.  The   verdicts
are  not  yet  in  on  them  as  treatments  for  nerve  damage,  so  I’m  listing  them  here
not  as  a  recommendation  but  simply  to  make  you  aware  of  them.
Alpha-lipoic   acid   appears   to   improve   neuropathy   symptoms.
3
   In   research
studies,  a  dose  of  600  milligrams  taken  once  daily  was  effective.
Gamma-linolenic   acid   is   an   omega-6   fatty   acid   commonly   sold   in   health
food   stores.   At   doses   of   480   milligrams   per   day,   it   appears   to   reduce
neuropathy  symptoms.
4
Carnitine,   in   doses   of   1,000   milligrams   daily,   appears   to   improve   nerve
condition  and  reduce  pain  in  patients  with  diabetic  neuropathy.
5
If  You  Have  Nerve  Damage
If  the  nerves  of  your  feet  have  been  damaged,  it  is  important  that  you  get  regular
checkups  and  protect   your  feet.  If  you   have  lost  some   feeling,  check   your  feet
daily  for  any  sign  of  injury  or  infection,  such  as  redness  or  swelling,  and  have  it
treated  right  away.  Avoid  walking  barefoot.  If  you  have  lost  some  feeling  in  your
feet,  you  may  not  know  if  you  step  on  something  that  breaks  the  skin.  Be  sure
your  shoes   fit  properly  to   avoid  blisters,   and  break  in   new  shoes   slowly.   Keep

your nails in good shape, and do not trim them shorter than the ends of your toes.

If your vision is poor or you have difficulty safely trimming your nails, have a

podiatrist examine your feet and trim your nails.

Needless to say, you will want to focus on more than just caring for your

feet. Fight back against neuropathy with a healthy diet—vegan, low-fat, and

low-GI.

HEALTHY EYES

Your eyes are delicate cameras that capture the world around you, transmitting

its details to your brain to perceive and remember. In the same way that a camera

is fragile, several parts of the eye are susceptible to damage. This is true for

anyone, but especially for people with diabetes. Protecting your eyes means

keeping your blood glucose, blood pressure, and cholesterol under control.

Three parts of the eye are particularly vulnerable. First, pressure can build up

in the front part of the eye—called the anterior chamber—and eventually

damage the retina and optic nerve. This is glaucoma. Second, a cataract can

compromise the lens’s clarity. Third, blood vessels in the retina can become

damaged. Let’s look at what we can do to prevent this three-pronged assault.

Glaucoma

There are several different types of glaucoma. Typically, increasing pressure

within the eye pinches the tiny blood vessels in the retina, damaging it and the

optic nerve. High blood pressure and high glucose levels both increase your risk

of developing glaucoma. Your best defense is to get both under control, using the

information in this chapter and the rest of this book. If glaucoma is caught early,

treatment (with prescription eye drops) is highly effective.

Glaucoma can begin with no symptoms at all, so it is important to have eye

examinations by an ophthalmologist at least once a year.

Cataracts

If the lens of the eye loses its clarity, becoming more like waxed paper than like

a clear pane of glass, a doctor diagnoses a cataract. You may experience blurred

or double vision, difficulty with distance vision, a halo effect around lights, or

excessive glare in bright sunlight or while driving at night.

While cataract surgery has advanced dramatically in recent years, the ideal

situation is to keep your original equipment in good working order. Luckily,

there  are  several  things  you  can  do  to  help  prevent  cataracts.
First,   it   is   important   to   avoid   tobacco   and   to   protect   your   eyes   from   harsh
sunlight.
Second,   it   pays   to   follow   the   same   diet   steps   that   apply   to   controlling
diabetes   in   general,   as   described   in   Chapter   4.   That   means   avoiding   animal
products,   keeping   oils   to   a   minimum,   and   favoring   low-GI   foods.   There   is
evidence  that  these  steps  reduce  your  risk.  Specifically,  people  who  avoid  fatty
foods  tend  to  have  less  cataract  risk.
6
The  same  appears  to  be  true  for  people  who  avoid  dairy  products.  Generally
speaking,  people  who  steer  clear  of  dairy  products  appear  to  have  significantly
less  risk  of  developing  cataracts.
7
  The  culprit  here  appears  to  be  lactose,  or  milk
sugar,  rather  than  milk  fat.
During  the  digestive  process,  lactose  releases  a  simple  sugar  called  galactose,
which  can  enter  the  lens.  Infants  who  lack  the  enzymes  necessary  to  break  down
galactose  develop  cataracts  within  the  first  year  of  life.  The  relationship  between
dairy   products   and   cataracts   is   still   being   studied,   but   this   is   one   more   good
reason  to  avoid  them.
Certain   foods   help   protect   the   eyes.   Particularly   valuable   are   green   leafy
vegetables   such   as   broccoli,   spinach,   kale,   collards,   and   mustard   greens.   They
are   rich   sources   of   certain   antioxidants,   called   lutein   and   zeaxanthin,   which
protect  both  the  lens  and  the  retina.
8
  Foods  rich  in  vitamins  c  and  E  may  help,
too.
9
   You   will   find   plenty   of   vitamin   c   in   oranges,   bell   peppers,   cantaloupe,
strawberries,   and   kiwifruit.   It   also   shows   up   in   places   you   may   not   expect:
cruciferous   vegetables—broccoli,   Brussels   sprouts,   cauliflower,   and   kale—as
well   as   tomatoes   and   sweet   potatoes.   Healthy   sources   of   vitamin   E   include
cooked  spinach,  soy   milk,  mangoes,   and  wheat  germ.   Most  nuts  and   seeds  are
particularly  rich  in  vitamin  E,  but  be  careful,  as  they  are  fatty  and  loaded  with
calories.  A  small  handful  has  about  5  milligrams  of  vitamin  E.
Finally,   people   who   avoid   alcohol   have   about   10   percent   less   cataract   risk
than  other  people.  Even  very  modest  consumption,  about  two  drinks  per  week,  is
linked  to  increased  risk.
10

Retinopathy

The retina, located at the back of your eye, is like camera film. Millions of tiny

nerves in the retina pick up images and send them to the brain. Also like film,

your retinas are fragile. They can be damaged by high blood sugar, blood

pressure, or cholesterol, leading to a condition called retinopathy, meaning

damage to the retina. The condition occurs in two main forms.

Nonproliferative retinopathy occurs when capillaries balloon out and leak

substances into the retina, leading to the formation of fatty deposits. The

condition is usually mild and needs no treatment, but it is essential that an

ophthalmologist check your eyes regularly to be sure that it does not become

more serious.

Proliferative retinopathy occurs when blood vessels are so damaged that

they begin to close off. When that happens, new, abnormal vessels start to form

in the retina. The new vessels are fragile and prone to bleeding, leading to

scarring and sometimes even to retinal detachment. Ophthalmologists use laser

treatments to treat the abnormal vessels.

Most people with diabetes eventually develop at least a mild degree of

retinopathy. The good news is that there is a lot you can do to prevent serious

problems. Good blood glucose control protects the eyes, and by now you know

how to go about attaining that. Keeping blood pressure and cholesterol down

helps, too. The diet steps above will go a long way toward helping you reach that

goal. If diet alone is insufficient, your doctor will add medications as needed.

Retinopathy begins without symptoms, so it is essential to have your eyes

checked regularly and to choose your foods as if your vision depended on it. It

does.

HEALTHY KIDNEYS

Your kidneys are made up of millions of tiny filtration units. They purify your

blood, sending waste products out into the urine and holding on to proteins and

other normal blood components. But just as the retina’s tiny blood vessels can be

damaged, so can the tiny vessels in your kidneys. High blood pressure, high

blood glucose, and high cholesterol assault them, leading to a condition doctors

call nephropathy.

left uncontrolled, kidney damage can progress to the point where your

options boil down to dialysis or kidney transplant. Needless to say, you do not

want anything like that to happen. Here are the diet steps you need to take.

First, follow the basic diet guidelines for diabetes as described in Chapter 4.

The need is not just for avoiding fat and cholesterol and keeping your blood

glucose and cholesterol down, although those are very important. Animal protein

is part of the problem, too, so you want to avoid it. Since animal protein taxes

the kidneys, getting your protein from plant sources helps protect them.

11

This is an important point, so stick with me while I explain: Many people

imagine that egg white, chicken breast, or haddock are healthful foods because

they are high in protein—but that very fact is what makes them undesirable. The

less animal protein you consume, the lower your risk of kidney problems. You

are much safer getting your protein from plant sources—beans, vegetables, and

grains, for example.

A low-fat, vegan diet is not only free of animal protein, cholesterol, and

animal fat, it also helps bring down high blood pressure,

12

which is also

important for protecting your kidneys.

It goes without saying that you should avoid tobacco. Among its many ill

effects, smoking damages blood vessels.

If your blood pressure, glucose, or cholesterol remains high despite your best

efforts, your doctor will prescribe medications to bring it under control. Some

doctors prescribe medications even if your tests are in the normal range, as a

means of protecting kidney tissues. This is done on an individualized basis.

In a recent study by our research team, we tracked the kidney health of our

participants. They dutifully collected their urine twice over two 24-hour periods

so we could measure their albumin losses (your doctor will probably use less

arduous tests). They did this before beginning their assigned new diets and again

after following them for 22 weeks.

During this time, a group following a “conventional” diet that involved

limited calories and carbohydrates had a 21 percent average drop in albumin

losses. That’s a change in the right direction. However, a group following a low-

fat vegan group had the advantage of consuming no animal protein, animal fat,

or cholesterol, and its average albumin losses were reduced 56 percent, that is,

they fell to less than half of their beginning values.

GETTING HEALTHY AND STAYING THAT WAY

If you have been gaining weight, needing more and more medications, or

developing complications, my goal is to help you change course. We now know

that it is possible to lose weight effectively and permanently, reduce or eliminate

medications, reverse heart disease, and even improve the symptoms of

neuropathy. If you thought you had to surrender to advancing symptoms, it’s

time to think again. You are now in the driver’s seat.

CHAPTER 14

Information for Clinicians

Although this book is intended as a tool for people with diabetes, there are a few

key points I would like to mention to physicians and other health care providers.

As you will see, this program is both very effective and highly engaging. While

health care providers are used to seeing their patients becoming frustrated with

typical “diabetes diets” and requiring ever-higher medication dosages, both

physicians and patients find this approach fresh and rewarding.

Health care providers play key roles for individuals on this program, just as

they do with any diabetes treatment program. They educate and encourage their

patients, guide them along the way, and monitor their progress.

In the research studies we have conducted, we have found that many patients

treated with insulin or insulin secretogogues have hypoglycemic episodes as they

improve their diets. As your patients embark on this new diet, you will need to

prepare them for that possibility and be ready to reduce their medications as

needed. It is also important that they understand that the hypoglycemia was

caused by the medications, not by any defect in their physiology. More on this

below.

THE ROLE OF THE HEALTH CARE PROVIDER

There are many ways physicians and other health care providers can help

patients as they begin major dietary changes. First, of course, is encouragement.

Many patients have seen their parents or grandparents end up with frightening

diabetes complications, such as eye problems, loss of kidney function, or

amputations, and many have already begun to experience neuropathy or other

problems by the time they decide to take the disease seriously. They need to

know that they can avoid these problems—as indeed they can—if they follow

your advice, including maintaining a good diet.

It is helpful for them to know that this is not the same diabetes diet they may

have already tried and that they will need to learn a few new tricks. They will

discover new products, new restaurants, and perhaps new menu items at their old

favorite restaurants. The most helpful physicians learn about these diet choices,

too. If you have not yet tried a low-fat, vegan diet, I would strongly encourage

you to do so. Apart from its health benefits, the experience will also prepare you

to answer patients’ questions and offer encouragement.

One way to help patients get started is to ask them to take a week to try out

healthful vegan foods. The idea is not to give up anything. Rather, they are just

trying out some healthful breakfasts, lunches, dinners, and snacks. In a few days,

they will have found many good ideas (more on this in Chapter 5).

Then identify a limited period—say, 3 weeks—in which to give the diet a

good try. For now, there is no need to commit to it forever, but during this short

period, they would do well to follow it 100 percent so they can experience its

full effect. Once they see how it works, they will want to continue.

Avoid the temptation to water down the diet. Clinicians who tell patients to

follow a diet “most of the time” or to “just do the best you can” tacitly encourage

them to deviate from it. We never do that when patients have alcohol or tobacco

problems, because we know that it is easier to stick to a consistent program than

to try to negotiate with these problem substances. The same is true of food; it is

better to encourage patients to give it 100 percent, never setting a foot wrong.

Occasionally, some patients will slip back into their old diet habits. When

that happens, they will almost instantly notice that they no longer manage their

weight as well, and their blood glucose levels will start to climb again. They will

also arrive at your office with a heavy burden of guilt. Many will speak of foods

as “sinful,” “decadent,” etc. I suggest that you remain positive, avoid moralizing,

and return the focus to biology, which is where it belongs. Patients who have

returned fat to their diets may well be packing their cells with more

intramyocellular lipid, which is likely to harm their insulin sensitivity.

Encourage them to dust themselves off and get back on the wagon.

Some patients need to be encouraged to eat carbohydrate-rich foods. Because

of the carbohydrate counting they have already learned, they may have come to

see all carbohydrates as unhealthful. This feeling was aided and abetted by the

never-ending low-carbohydrate diet craze. It is important to remind patients that

countries whose populations have traditionally consumed high-carbohydrate

diets—such as Asian countries, where rice and noodles are dietary staples and

meat and dairy consumption is much less prevalent than in Western countries—

have historically had very low diabetes rates.

You can also help patients ensure nutritional adequacy by asking them to

take a daily B

12

supplement. This is good advice for all patients.

HYPOGLYCEMIA

Patients who are taking insulin or insulin secretogogues are subject to

hypoglycemia. When they improve their diets and begin to lose weight,

hypoglycemic episodes are common. In my experience, most patients on insulin

and about half of all patients on a sulfonylurea who begin a low-fat, vegan diet

have hypoglycemic episodes, usually within the first several weeks.

Patients will be delighted to know that they have improved so much that

their medications are now too strong, but they will also be concerned about what

hypoglycemia means. It is important for them to understand that it was caused

by their medication and that it does not indicate that there is anything wrong

with them. It is also essential for them to know, right from the outset, what to do

and whom to call when these episodes happen. Of course, the initial steps—

checking their blood glucose and taking glucose tablets or food—are things they

can do on their own. But it is important to provide specific instructions and to

ask patients to carry your telephone number (or that of an office backup) with

them and use it as necessary—even on weekends—so you can adjust their

medications. You will find my instructions for patients on dealing with

hypoglycemia in Glucose Testing.

ADDITIONAL RESOURCES

Registered dietitians, as you know, are indispensable allies in your work with

diabetes patients. Ideally, you will want to work with a dietitian who is a

certified diabetes educator and a member of the Academy of Nutrition and

Dietetics’ Vegetarian Nutrition Dietetic practice Group, which includes a large

number of RDs skilled in the use of vegetarian diets.

The Physicians Committee for Responsible Medicine (PCRM) provides free,

noncommercial nutrition information, including continuing medical education on

its Web site, PCRM.org, as well as guidance on how to begin low-fat, vegan

diets. It provides hundreds of recipes, shopping lists, and other user-friendly

information. Please use it and encourage your patients to do so as well. They will

especially like our 21-Day Vegan Kickstart, which offers 3 weeks of menus,

recipes, and cooking videos in several languages, all for free.

If you would like to join in our work to promote healthful diets and tackle

other issues in medicine and research, I hope you will consider joining PCRM.

Members receive our quarterly magazine, Good Medicine, and can sign up to

receive pCRM’s Breaking Medical News, a free, noncommercial service that

alerts you by e-mail when new studies are about to break.

Menus and Recipes

The following menus and recipes were developed and tested by Bryanna Clark

Grogan, a veteran chef, recipe developer, and food writer. Originally from

California, Bryanna now lives in British Columbia. Her many cookbooks cover

an enormous range of foods and cooking styles, from quick and easy recipes to

many kinds of ethnic cuisine.

Bryanna’s recipes are full-bodied, savory dishes with a special “something.”

You will notice that their flavors go beyond the tastes and aromas of the

individual ingredients. The blends of simple foods and well-chosen spices make

each recipe special.

This recipe collection is intended for a wide range of tastes and

temperaments and includes both simple and more adventurous offerings. When

we have included an unusual ingredient, you can find more information in

Appendix 2. Thanks to Gabrielle Turner-McGrievy, PhD, RD, and Jennifer

Reilly, RD, who contributed additional recipes.

HOW TO STEAM-FRY

Some recipes call for steam-frying, a technique for sautéing or stir-frying

without fat. Here is how to do it.

Place a heavy nonstick skillet or stir-fry pan over medium heat and add the

ingredients to be cooked (e.g., chopped onions or other vegetables). Then add 1

to 2 tablespoons of liquid (water, low-sodium vegetable broth, or wine)—just

enough to keep the food from sticking. Do not crowd the pan, or the vegetables

will stew.

Increase the heat to high and cook until the liquid starts to evaporate, stirring

with a wooden spatula or spoon until the vegetables are done to your liking.

You can brown onions perfectly by this method. As soon as the natural

sugars in the onions start to brown on the bottom and edges of the pan, add a

little more liquid and mix the browned portions with the remaining onions.

Continue until the onions are soft and brown, being careful not to scorch them.

To steam-fry in a microwave, use a glass dish, such as a round 10-inch pyrex

baking dish or pie plate. Add the ingredients, including the 1 to 2 tablespoons of

liquid, and cover with a glass lid or microwaveable plate. Microwave on high for

5 minutes or until the vegetables are soft, then add to the recipe. As almost

everyone with a microwave knows, you can cook vegetables in it, but you

cannot brown them or any other food. If you like a brown, crispy texture, stick

with the stovetop method.

7  Days  of  Healthful  Meals
DAY  1
Breakfast
Oatmeal  cooked  with  apples
Soy  milk
Lunch
Black-Eyed  Pea  and  Sweet  Potato  Soup
Toasted  rye  or  sprouted-grain  bread
Spinach  salad  with   mandarin  orange   segments  and  Creamy  Poppy  Seed
Dressing
Snack
Fruit  Smoothie
Dinner
Lebanese-Style  Lentils  and  Pasta
Steamed  broccoli
Orange-Applesauce  Date  Cake
DAY  2
Breakfast
2  High-Protein  Oat  Waffles
Sliced  berries
Soy  yogurt
Lunch
Spinach  Hummus  and  vegetables  of  choice  wrapped  in  a  sprouted-wheat
tortilla

Orange  Quinoa  and  Bulgur  Tabbouleh
Snack
Baked  corn  chips,  salsa,  and  Vegetarian  “Refried”  Beans
Dinner
Indonesian-Style  Stir-Fried  Pasta
Thai-Style  Coleslaw
Fresh  fruit
DAY  3
Breakfast
Tofu  Scramblers
Rye  toast
Fruit  salad
Lunch
Panini  sandwich  made  with  sprouted-grain  bread,  Tofu  Mayonnaise,  low-
fat  vegetarian  deli  slices,  and  arugula
Creamy  Mushroom  Bisque
Snack
Apple  slices  dipped  in  Lemon  Crème
Dinner
Lemon  and  Artichoke  Tagine
Orange  Couscous  Pilaf
Baby  mixed  greens  salad  with  Creamy  Black  Pepper  Dressing
Berry  Mousse
DAY  4

Breakfast
Breakfast  Barley  with  Fruit
Soy  milk
Lunch
Red  Lentil  and  Sweet  Potato  Soup
Italian  Stuffed  Griddle  Dumplings
Snack
Raw  vegetables
Whole  grain  rye-crisp  crackers
Spinach  Dip
Dinner
Eggplant  Parmesan
Green  salad  with  Balsamic  Vinaigrette
Bulgur  Wheat  and  Quinoa  Pilaf
Fresh  fruit
DAY  5
Breakfast
Frozen  fat-free  hash  browns  baked  in  a  nonstick  waffle  iron
Low-fat  vegetarian  sausage
Sliced  oranges
Lunch
Black  Bean  Soft  Tacos
Cherry  Tomato  and  Brown  Rice  Salad  with  Artichoke  Hearts
Snack
Orange-Applesauce  Date  Cake

Nondairy  milk
Dinner
Balkan-Style  Slow-Cooker  Stew
Crusty  rye  bread
Brussels  Sprouts  with  Lemon  and  Vegetarian  Bacon
Fresh  fruit
DAY  6
Breakfast
Muesli  Cereal
Soy  milk
Fresh  fruit
Lunch
Sloppy  Joes  for  Two  on  sprouted-wheat  hamburger  buns
Green  salad
Snack
Whole  grain  crackers
Cypriot  Yellow  Split  Pea  and  Dill  Spread
Dinner
White  Bean  and  Sweet  Potato  Stew
Sprouted  grain  buns
Sautéed  Portobello  Mushroom  Salad
Cranberry–Orange–Pear  Granola  Crisp
DAY  7
Breakfast

Wheatberry  Pancakes  with  apple-cider  maple  syrup
Fresh  fruit
Lunch
Barley  and  Winter  Squash  Chowder
Oatmeal  Drop  Scones
Red  Cabbage  Slaw  with  Cranberries  and  Apples
Snack
Pineapple  Sherbet  Pops
Dinner
Vegetarian  Mixed-Bean  Chili  Express
Tender  Barley  Cornbread
BLT  Salad
Chocolate-Dipped  Strawberries

Breakfasts

Breakfast Barley with Fruit

For delicious taste, lots of soluble fiber, and a wonderfully low glycemic index,

try rolled barley (also called barley flakes) for your breakfast porridge. It takes a

bit longer to cook than oatmeal unless you soak it the night before. Serve with

your favorite nondairy milk and a touch of brown sugar or the sweetener of your

choice.

⅓ cup rolled barley (barley flakes)

⅛ teaspoon salt

¾ cup water

1 tablespoon wheat bran

½ medium apple with peel, cored and chopped, or other chopped fruit

1½ teaspoons ground flaxseed

The night before: Combine the barley, salt, and water in a microwaveable bowl,

cover, and refrigerate overnight. (Use a 1-quart or larger bowl—barley can really

boil up!)

In the morning: Add the bran and apple or other fruit to the soaked barley. Cover

the bowl with a microwaveable plate and microwave on high for 2 minutes.

Finish cooking on medium for 4 minutes. Stir in the flaxseed.

To cook on the stovetop: Bring the soaked barley, bran, and apple or other fruit to

a boil in a small nonstick saucepan over high heat, stirring. Reduce the heat to

low, partially cover, and simmer for about 15 minutes, stirring occasionally. The

mixture should have the consistency of cooked oatmeal. If it’s too watery,

continue cooking over low heat to desired consistency.

MAKES 1 SERVING

Per serving: 197 calories, 6 g protein, 8 g carbohydrates, 8 g sugar, 2 g total fat,

10% calories from fat, 0 mg cholesterol, 42 g fiber, 252 mg sodium

Tofu Scramblers

It takes about the same amount of time to make Tofu scramblers as it does to

make scrambled eggs when you use the handy homemade mix. Shake or stir the

mix before measuring. Scramblers can be used in breakfast burritos or soft tacos

made with sprouted wheat or corn tortillas, topped with salsa, or used in vegan

huevos rancheros.

Scrambler Mix

1 cup nutritional yeast flakes

5 tablespoons + 1 teaspoon onion powder

4 teaspoons curry powder

4 teaspoons salt

4 teaspoons ground turmeric

4 teaspoons ground cumin

Scramblers

1½ teaspoons Tofu scrambler Mix

4 ounces reduced-fat extra-firm silken tofu, crumbled

2 tablespoons reduced-fat soy milk (optional)

For the mix: Blend the yeast flakes, onion powder, curry powder, salt, turmeric,

and cumin in a dry blender or mini-processor. Store in a covered jar.

For the scramblers: Combine the scrambler mix and tofu well in a medium

bowl. Add the soy milk, if desired. Cook the mixture in a heavy nonstick skillet

until it reaches the desired consistency, stirring constantly with a plastic spatula.

To microwave, combine the ingredients in a microwaveable dish, cover, and

cook on high (for 4 ounces, about 2 minutes; for 8 ounces, about 3½ minutes; for

12 ounces, about 5 minutes; and for 16 ounces, about 7½ minutes).

MAKES 1 SERVING

Per serving: 54 calories, 9 g protein, 3 g carbohydrates, 1 g sugar, 1 g total fat,

15% calories from fat, 0 mg cholesterol, 1 g fiber, 252 mg sodium

Variations

If you like, add chopped vegetarian bacon or ham; vegetarian bacon bits; or

steam-fried chopped onions, scallions, mushrooms, bell peppers, or tomatoes. If

cooking in the microwave, place the vegetables in the bottom of the dish, put the

tofu (mixed with the scrambler mix) on top, and cook as usual, then stir together

before serving.

Muesli Cereal

Bircher muesli was invented in Switzerland as a nutritious raw but digestible

breakfast cereal. You can buy expensive commercial versions, but the original is

low in fat, easy to make, and quick, as long as you remember to start the night

before. Serve muesli with reduced-fat nondairy milk or soy yogurt; brown sugar,

maple syrup or agave syrup to taste; and fresh fruit (such as berries), if desired.

1½ cups rolled oats or other rolled whole grain cereal

1½ cups water

2 tablespoons wheat bran

2 tablespoons currants, raisins, or other dried fruit

¼ teaspoon salt

2 medium apples with peel, grated

3 tablespoons lemon juice

The night before: Combine the oats and water in a bowl and refrigerate

overnight.

Just before serving: Add the bran, currants or raisins, salt, apples, and lemon

juice to the soaked oats.

Note: To make 1 serving, use 6 tablespoons oats; 6 tablespoons water; 1

teaspoon bran; 1 teaspoon dried fruit; a pinch of salt; ½ small apple, shredded;

and 2¼ teaspoons lemon juice.

MAKES 4 SERVINGS

Per serving: 173 calories, 6 g protein, 36 g carbohydrates, 11 g sugar, 2 g total

fat, 10% calories from fat, 0 mg cholesterol, 6 g fiber, 122 mg sodium

Oatmeal Drop Scones

Traditional Scottish skon recipes contained no fat at all. They were eaten

immediately, warm and fresh, as these should be. Enjoy them with low-sugar

jam.

1 cup old-fashioned oats

1¼ cups whole wheat pastry flour (not regular whole wheat flour)

1 teaspoon sugar

½ teaspoon baking soda

½ teaspoon salt

1¼ cups reduced-fat soy milk

1 tablespoon lemon juice or vinegar

Sugar or caraway seed

Preheat the oven to 400°F. Grind the oats to a fine meal in a dry blender. Pour

into a medium bowl and add the flour, sugar, baking soda, and salt. Mix well.

Mix the soy milk and lemon juice or vinegar in a small bowl. Pour into the dry

mixture and stir briefly with a fork. Drop by large spoonfuls onto 2 nonstick

baking sheets (or baking sheets lined with parchment), making 12 mounds.

Smooth the tops a bit with wet fingertips. Bake for about 15 minutes. Split with

a fork while still hot.

For a bannock shape: Divide the dough in half. With wet hands, pat the dough

pieces into 8" circles in two 9" nonstick cake pans (or cake pans lined with

parchment cut to fit). Score each circle into 6 wedges and bake for 15 to 20

minutes.

Sprinkle with the sugar or caraway seed.

MAKES 12 SERVINGS

Per serving: 77 calories, 3 g protein, 15 g carbohydrates, 1 g sugar, 1 g total fat,

9% calories from fat, 0 mg cholesterol, 2 g fiber, 144 mg sodium

Variations

Currant Scones: Add ¼ to ½ cup dried currants. You can also add ¾ cup grated

apple.

Herb Scones: Add ½ cup loosely packed chopped fresh herbs of your choice.

Herb Bannock: This resembles a focaccia, is quick to make, and is a great snack.

Add ½ cup fresh herbs to the oatmeal scone dough. Divide the dough in half and

follow the instructions for making the bannock shape. Make indentations all over

the dough with your fingertips. Spray the tops lightly with water from a pump

sprayer and sprinkle with coarse salt or soy Parmesan, or top with steam-fried

or grilled chopped mushrooms, garlic, bell peppers, and/or onions. Serve with

balsamic vinegar for dipping.

Tender Barley Cornbread

You can whip up this high-fiber, low-fat cornbread fast, and it bakes in 15

minutes. Use stone-ground cornmeal if you can.

¾ cup yellow cornmeal

½ cup barley flour

⅓ cup whole wheat flour (regular or pastry flour)

2 tablespoons sugar

2 teaspoons baking powder

½ teaspoon salt

¼ teaspoon baking soda

1 cup reduced-fat soy milk

¼ cup unsweetened applesauce

Preheat the oven to 425°F. Whisk together the cornmeal, barley and whole wheat

flours, sugar, baking powder, salt, and baking soda in a medium bowl. Add the

soy milk and applesauce and stir just until mixed. Scrape into an 8" × 8"

nonstick baking pan and smooth the top. Bake for 15 minutes. Cut the hot

cornbread into 6 equal pieces.

MAKES 6 SERVINGS

Per serving: 150 calories, 4 g protein, 32 g carbohydrates, 5 g sugar, 1 g total

fat, 6% calories from fat, 0 mg cholesterol, 3 g fiber, 237 mg sodium

High-Protein Oat Waffles

If you didn’t make these crisp, ultra-nutritious waffles yourself, you’d never

guess beans were among the ingredients. Soaking the beans takes just minutes

before you retire for the night, and in the morning, you can make the batter

quickly in the blender. (Note: To cook waffles without added fat, you will need a

good-quality nonstick waffle iron.)

These waffles take a little longer to bake than ordinary waffles (about 8

minutes), so you may want to make them ahead of time. They can be reheated

quickly in a toaster. Topped with chili or creamed vegetables, they make a great

lunch or supper. For gluten-free waffles, substitute brown rice flakes or quinoa

flakes for the oats.

½ cup dried cannellini, white kidney, or great northern beans

2¼ cups water

1¾ cups old-fashioned oats

2 tablespoons sugar or 1 tablespoon agave nectar

¾ tablespoon whole flaxseed

1 tablespoon baking powder

1½ teaspoons vanilla extract, or ¾ teaspoon vanilla extract and ¾ teaspoon

orange, almond, or coconut extract

1 teaspoon salt

The night before: Place the beans in a large bowl and cover generously with

water. Refrigerate overnight or for up to a week.

In the morning: Drain the beans, discarding the soaking water. Place in a blender

with 2¼ cups fresh water and the oats, nectar, flaxseed, baking powder, vanilla,

and salt. Blend until smooth, light, and foamy. Set aside and preheat a nonstick

waffle iron.

Pour a generous ⅓ cup of batter onto the hot waffle iron for each 4" waffle, close

the iron, and cook for a minimum of 8 minutes. If the iron is hard to open, let the

waffle cook for another minute or two.

Repeat with the remaining batter, blending briefly before pouring each waffle. If

the batter thickens while standing, add enough water to return it to its original

consistency.

The waffles should be golden brown and crisp. Serve immediately or cool

completely on a rack and freeze in an airtight container. Serve with your favorite

toppings.

MAKES TEN 4" WAFFLES (5 SERVINGS)

Per serving: 196 calories, 10 g protein, 35 g carbohydrates, 2 g sugar, 3 g total

fat, 11% calories from fat, 0 mg cholesterol, 6 g fiber, 386 mg sodium

Wheatberry Pancakes

Who would guess that with the help of your blender, you could make deliciously

light pancakes from freshly ground wheat in minutes? Try these! Leftover batter

works great for waffles, too.

1 cups wheat berries (whole wheat kernels)

1 tablespoon whole flaxseed

2 cups water

⅓ cup chickpea flour (besan) or low-fat soy flour

1 tablespoon sugar

2 teaspoons lemon juice

2 teaspoons baking powder

½ teaspoon baking soda

½ teaspoon salt

Place the wheat berries, flaxseed, and water in a blender and process at high

speed for about 2 minutes. Add the flour and process for 2 to 3 minutes or until

very smooth. Add the sugar, lemon juice, baking powder, baking soda, and salt

and process until well mixed.

Heat a heavy nonstick griddle or skillet (a nonstick electric griddle cooks very

evenly) over high heat until drops of water dance on the surface and then quickly

disappear. Reduce the heat to medium-high. Working in batches if necessary,

pour dollops of batter quickly onto the griddle, leaving space to expand. When

bubbles appear on the surface, gently flip the pancakes. Don’t overcook; they

should be a bit puffy when you take them off the griddle, so they are light and

cakey.

MAKES TWELVE 4" PANCAKES (3 SERVINGS)

Per serving: 261 calories, 11 g protein, 53 g carbohydrates, 6 g sugar, 3 g total

fat, 9% calories from fat, 0 mg cholesterol, 9 g fiber, 534 mg sodium

Fruit Smoothie

This quick and easy recipe is great way to start your day—or give you a healthy

boost anytime.

½ cup unsweetened apple or orange juice

½ cup reduced-fat soy milk

½ cup frozen blueberries or other berries

½ cup frozen peaches

1 tablespoon soy protein powder

Combine the juice, soy milk, berries, peaches, and protein powder in a blender

or food processor. Blend until very smooth.

MAKES 1 SERVING

Per serving: 148 calories, 4 g protein, 32 g carbohydrates, 13 g sugar, 2 g total

fat, 9% calories from fat, 0 mg cholesterol, 3 g fiber, 65 mg sodium

Dips, Spreads, and Dressings

Low-Fat Guacamole

This “mock-amole” is creamy and tasty. It is delicious with baked corn tortilla

chips.

5 ounces fresh green beans or frozen small whole green beans

5 ounces frozen baby lima beans

½ cup reduced-fat firm or extra-firm silken tofu

3 tablespoons lemon juice

2 cloves garlic, crushed

¾ teaspoon salt

½ teaspoon ground cumin

¼ cup chunky no-sugar-added tomato salsa

Cook the green beans and lima beans in enough water to cover for about 5

minutes or just until tender but not mushy. Drain well, transfer to a food

processor, and blend until smooth.

Add the tofu, lemon juice, garlic, salt, and cumin and blend until smooth. Add

the salsa and pulse briefly to mix. Scoop into a covered bowl and refrigerate.

MAKES 2 CUPS

Per ¼ cup: 37 calories, 2 g protein, 7 g carbohydrates, 1 g sugar, 0.5 g total fat,

5% calories from fat, 0 mg cholesterol, 2 g fiber, 226 mg sodium

Vegetarian “Refried” Beans

This fat-free version of refried beans has a light texture and can be made with a

variety of beans. It also makes a great warm bean dip or a delicious cold spread

for sandwiches, wraps, or crackers.

4½ cups cooked or 3 cans (15 ounces each) black, small red, kidney, or pinto

beans, rinsed and drained

1 small onion, finely chopped

2 tablespoons red wine vinegar

1 teaspoon salt

1 teaspoon ground cumin

1 teaspoon dried oregano

1 teaspoon dried garlic granules

1 teaspoon chili powder

Hot-pepper sauce to taste (optional)

A few dashes of liquid smoke (optional)

Place the beans, onion, vinegar, salt, cumin, oregano, garlic granules, chili

powder, hot-pepper sauce, if desired, and liquid smoke, if desired, in a food

processor. Blend for several minutes or until very smooth. Transfer to a serving

bowl, cover, and refrigerate.

For a hot dip, microwave on high for about 3 minutes or heat in a skillet, stirring

constantly.

MAKES 4 CUPS

Per ¼ cup: 68 calories, 4 g protein, 12 g carbohydrates, 0.5 g sugar, 0.5 g total

fat, 4% calories from fat, 0 mg cholesterol, 4 g fiber, 120 mg sodium

Spinach Hummus

Most versions of this popular Middle Eastern chickpea dip are chock-full of

olive oil and sesame tahini. This recipe contains a little tahini and plenty of

spinach or other greens for good nutrition and lots of color. Serve with raw

veggies and wedges of sprouted-wheat pita bread or with fat-free dark rye-crisp

crackers. Heating the chickpeas before processing makes a creamier hummus.

1 package (10 ounces) frozen spinach, thawed

2 cups well-cooked chickpeas or 1 can (19 ounces) chickpeas, heated and

drained

⅓ cup lemon juice

1 tablespoon sesame tahini

4–6 cloves garlic

1½ teaspoons salt

1 teaspoon ground cumin

¼ teaspoon cayenne pepper

Squeeze as much liquid from the spinach as you can and chop with a sharp knife.

Set aside.

Place the chickpeas, lemon juice, tahini, garlic, salt, cumin, and cayenne in a

food processor. Blend until as smooth as desired, adding a bit of water if

necessary (it will thicken somewhat in the refrigerator). Add the spinach and

blend briefly.

Transfer to a serving bowl, cover with plastic wrap, and refrigerate until ready to

serve.

MAKES ABOUT 3½ CUPS

Per ¼ cup: 107 calories, 7 g protein, 19 g carbohydrates, 0.5 g sugar, 2 g total

fat, 13% calories from fat, 0 mg cholesterol, 6 g fiber, 336 mg sodium

Variations

Try this recipe with cooked or thawed frozen kale, Swiss chard, or collard greens

instead of spinach.

For a more traditional hummus, omit the greens and decrease the salt to 1

teaspoon, the cumin to ½ teaspoon, and the cayenne to a pinch.

For delicious red pepper hummus, make the traditional hummus variation and

add ½ cup drained and rinsed roasted red peppers from a jar when you process

the chickpeas.

Cypriot Yellow Split Pea and Dill Spread

This easy spread is delicious with dark rye-crisp crackers or sprouted-wheat pita

wedges. The garlic mellows considerably when cooked.

1 cup dried yellow split peas

7 cloves garlic

1 small onion, chopped

1 teaspoon salt

3 cups water

3 tablespoons fresh lemon juice

2 teaspoons dried dill weed or 2 tablespoons chopped fresh dill

Freshly ground black pepper to taste

Paprika (optional)

1 sprig fresh dill (optional)

Combine the split peas, 6 of the garlic cloves, onion, salt, and water in a medium

saucepan. Bring to a boil, skimming off any foam. Reduce the heat, cover, and

simmer for 30 minutes.

Transfer to a food processor or blender and process, or use a hand-held blender

in the pan. (Remove the “pusher” from the top of the food processor so hot air

can escape. Cover the hole loosely with a folded clean cloth while processing.)

crush the remaining garlic clove and add to the mixture along with the lemon

juice and dill. Process until very smooth. Season with the pepper.

Pour into a decorative serving bowl, cover, and let cool. Garnish with the paprika

and dill sprig, if desired.

This spread is best served at room temperature. If you store it in the refrigerator,

simply bring it to room temperature before serving.

MAKES 2½ CUPS

Per ¼ cup: 74 calories, 5 g protein, 14 g carbohydrates, 2 g sugar, 0.5 g total

fat, 2% calories from fat, 0 mg cholesterol, 5 g fiber, 193 mg sodium

Red Wine Vinaigrette

This is a good basic dressing for many types of salads. Unlike plain juice or

water, the oil substitute will help the dressing stick to the greens. I like to make 2

cups at a time and refrigerate the extra.

Fat-Free oil Substitute

1 cup cold water

1 tablespoon low-sodium vegetarian broth powder

2 teaspoons cornstarch

Dressing

1¼ cups Fat-Free Oil Substitute

¼ cup red wine vinegar

1 tablespoon balsamic vinegar

1 clove garlic, crushed

1 teaspoon salt

1 tablespoon Dijon mustard (optional)

1 tablespoon brown sugar (optional)

For the oil substitute: Place the water in a small saucepan and whisk in the broth

powder and cornstarch. Cook over medium-high heat, stirring constantly, until

thickened and clear.

For the dressing: Whisk, shake, or blend the oil substitute, red wine and

balsamic vinegars, garlic, salt, mustard, if desired, and sugar, if desired, until

well mixed. Transfer to a jar and refrigerate.

MAKES 1½ CUPS

Per 2 tablespoons: 6 calories, 0.5 g protein, 2 g carbohydrates, 0 g sugar, 0 g

total fat, 0% calories from fat, 0 mg cholesterol, 0.5 g fiber, 160 mg sodium

Variation

Balsamic Vinaigrette: Omit the red wine vinegar and use 5 tablespoons balsamic

vinegar. Use the optional mustard and brown sugar.

Per 2 tablespoons: 11 calories, 0.5 g protein, 3 g carbohydrates, 1 g sugar, 0.5 g

total fat, 3% calories from fat, 0 mg cholesterol, 0.5 g fiber, 176 mg sodium

Spinach Dip

Serve this blender dip with raw vegetables and/or fat-free dark rye-crisp

crackers.

20 ounces reduced-fat extra-firm silken tofu

¼ cup lemon juice

1 envelope Lipton Recipe Secrets Vegetable Soup Mix

½ teaspoon salt

1 package (10 ounces) frozen chopped spinach, thawed and squeezed dry

2 scallions, minced

1 can (8 ounces) water chestnuts, drained and chopped (optional)

1 tablespoon vegetarian bacon bits (optional)

Place the tofu, lemon juice, soup mix, and salt in a food processor and blend

until smooth. Add the spinach, scallions, water chestnuts, if desired, and bacon

bits, if desired, and pulse until mixed. Transfer to a serving bowl, cover, and

refrigerate until ready to serve.

MAKES 4 CUPS (12 SERVINGS)

Per serving: 16 calories, 1 g protein, 3 g carbohydrates, 1 g sugar, 0.5 g total

fat, 10% calories from fat, 0 mg cholesterol, 1 g fiber, 226 mg sodium

Creamy Poppy Seed Dressing

This quick and easy dressing is very low in fat. With just the right amount of

sweetness, it’s great on fruit salads and spinach salads.

8 ounces reduced-fat firm or extra-firm silken tofu, crumbled

6 ounces (½ can) frozen apple juice concentrate, thawed

6 tablespoons reduced-fat soy milk

3 tablespoons cider vinegar

1 tablespoon poppy seeds

1½ tablespoons chopped onion

1½ tablespoons dijon mustard

1 scant teaspoon salt

Place all the ingredients in a blender and process until smooth. Transfer to a jar

and refrigerate. Shake before serving.

MAKES 2 CUPS

Per ¼ cup: 45 calories, 3 g protein, 7 g carbohydrates, 1 g sugar, 1 g total fat,

18% calories from fat, 0 mg cholesterol, 0.5 g fiber, 268 mg sodium

Creamy Black Pepper Dressing

This is sure to be a favorite, especially if you are a fan of spinach salads. The

blender is the key to the creamy texture.

1½ tablespoons low-sodium vegetarian broth powder

1 package (12.3 ounces) reduced-fat firm silken tofu

1 large clove garlic, finely chopped

3 tablespoons fresh lemon juice

1 tablespoon rice vinegar

1 tablespoon nutritional yeast flakes

1½ teaspoons whole black peppercorns

1 teaspoon miso

1 teaspoon sugar

¾ teaspoon salt

⅔ cup water

Place all the ingredients in a blender and process until very smooth. Transfer to a

jar and refrigerate. Shake well before serving.

MAKES 2 CUPS

Per 2 tablespoons: 15 calories, 2 g protein, 2 g carbohydrates, 0.5 g sugar, 0.5 g

total fat, 11% calories from fat, 0 mg cholesterol, 0.5 g fiber, 123 mg sodium

Soups

Dutch Green Pea Soup

A very satisfying meal on a cold day! Serve this soup hot along with dark

pumpernickel bread.

1 cup green split peas

8 cups low-sodium vegetarian broth

1 tablespoon vegetarian bacon bits

2 medium new or red potatoes, peeled and chopped

2 medium leeks, chopped, including any tender green parts

½ cup chopped celery, including leaves

½ teaspoon dried savory

½ teaspoon liquid smoke

1 package (10–12 ounces) low-fat vegetarian hot dogs or sausages, sliced

diagonally into chunks

Salt to taste

Freshly ground black pepper to taste

Bring the split peas, broth, and bacon bits to a boil in a large saucepan,

skimming off any foam. Reduce the heat, cover, and simmer for about 3 hours.

Add the potatoes, leeks, celery, savory, liquid smoke, and hot dogs or sausages.

Simmer for 30 minutes or until the potatoes are tender. Season with the salt and

pepper.

MAKES 8 SERVINGS

Per serving: 184 calories, 15 g protein, 27 g carbohydrates, 3 g sugar, 3 g total

fat, 11% calories from fat, 0 mg cholesterol, 7 g fiber, 36 mg sodium

Barley and Winter Squash Chowder

This is a lovely soup for a cold evening.

4 cups low-sodium vegetarian broth

1 pound winter squash, peeled, seeded, and cut into ¾" cubes

½ large onion, chopped

6 ounces low-fat chicken substitute strips, such as Butler Soy Curls,

reconstituted

¾ cup pearled barley

8 ounces red potatoes, chopped

¼ cup chopped celery leaves and tops

1½ teaspoons vegetarian bacon bits

1 bay leaf

½ teaspoon dried thyme

½ teaspoon dried savory

1½ cups reduced-fat soy milk

Salt to taste

Freshly ground black pepper to taste

Chopped fresh parsley (optional)

Place the broth, squash, onion, chicken substitute strips, barley, potatoes, celery,

bacon bits, bay leaf, thyme, and savory in a soup pot and bring to a boil. Reduce

the heat to low, cover, and simmer for 30 minutes. Remove the bay leaf, stir in

the soy milk, and season with the salt and pepper. Sprinkle each serving with

chopped parsley, if desired.

MAKES 6 SERVINGS

Per serving: 204 calories, 11 g protein, 40 g carbohydrates, 4 g sugar, 1 g total

fat, 4% calories from fat, 0 mg cholesterol, 8 g fiber, 229 mg sodium

Creamy Mushroom Bisque

A food processor turns this dairy-free soup into a rich, creamy treat with a

delightful mushroom flavor.

1 small onion, finely chopped

5 cups mushroom broth

1 bay leaf

½ teaspoon dried thyme

⅔ cup old-fashioned oats

12 ounces mushrooms, sliced

2 teaspoons low-sodium soy sauce

2 tablespoons dry sherry (optional)

Salt to taste

Freshly ground black pepper to taste

Vegan Parmesan cheese (optional)

Steam-fry the onion in a heavy nonstick skillet over medium heat until soft but

not browned, adding very small amounts of water as needed to prevent sticking

and burning. (Or place in a microwaveable dish, cover, and microwave on high

for 3 minutes.)

Place the broth, bay leaf, thyme, and oats in a medium saucepan. Add the onion

and bring to a boil, then reduce the heat to low, cover, and simmer for 20

minutes or until the oats are soft.

Meanwhile, steam-fry the mushrooms in a large, heavy nonstick skillet over high

heat, adding a sprinkle of salt and very small amounts of water as needed to

prevent sticking and burning. Cook until the mushrooms release and reabsorb

their liquid. Remove from the heat and set aside.

When the oats are soft, remove the bay leaf and puree the soup until creamy with

a hand-held blender or in batches in a blender or food processor. (Remove the

middle part of the blender or food processor’s lid so hot air can escape. Cover

the hole loosely with a folded clean cloth while blending.)

Return the soup to the pan and add the mushrooms, soy sauce, sherry (if

desired), salt, pepper, and vegan Parmesan (if desired). Serve hot.

MAKES 4 SERVINGS

Per serving: 80 calories, 5 g protein, 14 g carbohydrates, 3 g sugar, 1 g total fat,

12% calories from fat, 0 mg cholesterol, 3 g fiber, 93 mg sodium

Black-Eyed Pea and Sweet Potato Soup

This delectable soup contains Southern ingredients—black-eyed peas, vegetarian

bacon and sausage, sweet potatoes, and greens.

1 large onion, chopped

3 cloves garlic, minced

6 cups low-sodium vegetarian broth

¼ cup tomato paste

3 cups cooked or 2 cans (15 ounces each) black-eyed peas, rinsed and drained

2 tablespoons vegetarian bacon bits or a few dashes of liquid smoke

2 teaspoons dried oregano

1 bay leaf

½ teaspoon salt

½ teaspoon crushed red pepper

4 ounces kale, collards, or other dark greens, cleaned, trimmed, and thinly

sliced

1 pound sweet potatoes, peeled and chopped

2 vegetarian italian sausages, such as Lightlife smart Links italian or Yves

Veggie Spicy Italian Sausage, cut into ¼" slices

Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium

heat until soft, adding very small amounts of water as needed to prevent sticking

and burning. (Or place in a microwaveable dish, cover, and microwave on high

for 5 minutes.)

Place the broth, tomato paste, black-eyed peas, bacon bits or liquid smoke,

oregano, bay leaf, salt, red pepper, greens, sweet potatoes, and sausage in a large

saucepan. Add the onion and garlic and simmer for 30 minutes or until the sweet

potatoes are tender. Remove the bay leaf and serve immediately.

MAKES 6 SERVINGS

Per serving: 257 calories, 16 g protein, 44 g carbohydrates, 8 g sugar, 3 g total

fat, 10% calories from fat, 0 mg cholesterol, 10 g fiber, 263 mg sodium

Red Lentil and Sweet Potato Soup

This hearty soup makes a great light lunch or a starter for a several-course meal.

Blending gives it a delightfully smooth texture.

2 small onions, chopped

½ teaspoon ground cumin

½ teaspoon ground ginger

4 cups low-sodium vegetarian broth

2 cups cubed peeled sweet potatoes

⅔ cup red or pink lentils, rinsed

1 teaspoon lemon juice

¼ teaspoon salt

White pepper to taste

Paprika

Steam-fry the onions in a large, heavy nonstick skillet over medium heat until

soft, adding very small amounts of water as needed to prevent sticking and

burning. (Or place in a microwaveable dish, cover, and microwave on high for 5

minutes.) stir in the cumin and ginger and blend well.

Place the broth, sweet potatoes, and lentils in a medium soup pot. Add the

onions and simmer, uncovered, for about 30 minutes or until the lentils are

tender. Add the lemon juice, salt, and white pepper. Process using a hand-held

blender in the pan or in batches in a blender or food processor, until creamy.

(Remove the middle part of the blender or food processor lid so hot air can

escape. Cover the hole loosely with a folded clean cloth while blending.) Serve

hot and with paprika sprinkled on top of each bowl.

MAKES 4 SERVINGS

Per serving: 185 calories, 10 g protein, 36 g carbohydrates, 4 g sugar, 1 g total

fat, 3% calories from fat, 0 mg cholesterol, 6 g fiber, 158 mg sodium

Sandwiches and Salads

Black Bean Soft Tacos

In Mexico, tacos are usually made with fresh, hot tortillas (not deep-fried ones).

This machine-blended filling brings you all the traditional taste and heartiness of

the real thing.

Tofu Sour Cream

1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled

3 tablespoons lemon juice

½ teaspoon sugar

¼ teaspoon salt

Tacos

8 corn tortillas (6")

1½ cups Vegetarian “Refried” Beans made with black beans

2 cups (1 recipe) Low-Fat Guacamole

1 cup no-sugar-added tomato salsa

4 cups finely shredded green cabbage or lettuce

1 cup Tofu sour cream

For the tofu sour cream: Place the tofu, lemon juice, sugar, and salt in a food

processor or blender and process until very smooth. Refrigerate in a covered

container for up to 1 week.

For the tacos: Heat the tortillas (see Note). Spread about 3 tablespoons of beans

down the middle of each tortilla. Top with guacamole, salsa, cabbage or lettuce,

and tofu sour cream. Eat out of hand with lots of napkins!

Note: If the tortillas are frozen, heat them between two microwaveable plates on

high for about 1 minute, then turn over the plates and heat for 1 minute longer.

You can soften thawed or fresh tortillas in a hot, dry pan; grill them quickly just

until soft; or wrap them in a clean kitchen towel moistened with hot water, then

wrap them in foil and place them in the oven until all are heated. Or, wrap the

tortillas in a clean kitchen towel moistened with hot water, wrap them in foil, and

bake them in a 350°F oven for about 12 minutes.

If you have a noninsulated microwaveable steamer, place a little hot water under

the steamer tray. Wrap the thawed tortillas in a clean kitchen towel and place

them in the steamer tray. Cover and microwave for 2 to 3 minutes for 6 tortillas

or 4 minutes for 12 tortillas. If you leave the wrapped tortillas in the steamer,

they will stay hot during the meal.

MAKES 8 SERVINGS

Per serving: 174 calories, 10 g protein, 33 g carbohydrates, 3 g sugar, 1 g total

fat, 7% calories from fat, 0 mg cholesterol, 7 g fiber, 557 mg sodium

Asparagus and Veggie Ham Panini

This Italian panini will become a lunchtime favorite.

2 slices rye or sprouted-grain bread

2 tablespoons Tofu Mayonnaise

6 thin asparagus spears, steamed or roasted

6 fresh basil leaves

2 slices low-fat vegetarian bacon or ham, such as Yves Veggie Canadian

Bacon

Spread each bread slice on 1 side with 1 tablespoon tofu mayonnaise and

assemble the sandwich with the rest of the ingredients the way you like it, being

careful not to overfill.

The easiest way to make panini is with an electric nonstick panini press or closed

indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as

golden and crisp as you like, cook for a few minutes longer. Cut the sandwich

into triangles and serve hot.

If you do not have a panini press or grill, cook the sandwich in a heavy nonstick

skillet or on a griddle over medium heat, placing a flat heavy lid on the sandwich

as you brown each side.

Per serving (using rye bread): 308 calories, 31 g protein, 32 g carbohydrates,

0.2 g sugar, 4 g total fat, 11% calories from fat, 0 mg cholesterol, 6 g fiber, 825

mg sodium

Italian Stuffed Griddle Dumplings (Consum)

This traditional “griddle dumpling” from Romagna is actually a stuffed Italian

flatbread, similar to a calzone but stuffed with greens. This easy version uses

whole wheat pitas.

6 whole wheat pitas

½ pound Swiss chard, beet greens, spinach, or savoy cabbage, or a mixture

½ pound bitter greens, such as arugula, radicchio, rapini, Chinese broccoli,

mustard or turnip greens, or curly endive

1½ teaspoons chopped garlic

¼ cup low-sodium vegetarian broth

¼ teaspoon salt, and extra to taste

Freshly ground black pepper to taste

Cut the pitas in half and open to form a pocket. Wash, trim, and thinly slice the

greens.

Place the garlic, broth, greens, and salt in a large, deep nonstick skillet. Bring to

a boil, then cover, reduce the heat to medium, and cook until tender. If any liquid

remains, uncover and cook over high heat, stirring constantly, until it evaporates.

Season with the salt and pepper and set aside to cool.

Drain the greens and stuff inside the pita halves. Heat the filled pitas on a hot,

dry griddle or cast-iron pan over high heat, turning frequently, until hot and

flecked with brown spots. Serve hot.

MAKES 6 SERVINGS

Per serving: 188 calories, 8 g protein, 38 g carbohydrates, 2 g sugar, 2 g total

fat, 8% calories from fat, 0 mg cholesterol, 6 g fiber, 510 mg sodium

Mediterranean Veggie Panini

Italian sandwich making has become an art form in the northern city of Milan

and has spread all over Europe and North America. Sandwich bars in italy range

from humble places to the height of sophistication, and some offer as many as 30

varieties.

2 slices rye or sprouted-grain bread, such as Ezekiel Bread

2 tablespoons fat-free italian vinaigrette dressing

2 jarred roasted red peppers, rinsed and patted dry

1 cup tender kale leaves or other greens

2 small firm, ripe tomatoes, sliced (fresh Roma tomatoes are best because they

are not overly juicy)

½ cup sliced marinated artichoke hearts, rinsed, drained, and patted dry

Moisten each bread slice on 1 side with 1 tablespoon dressing and assemble the

sandwich with the rest of the ingredients the way you like it, being careful not to

overfill.

The easiest way to make panini is with an electric nonstick panini press or closed

indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as

golden and crisp as you like, cook for a few minutes longer. Cut the sandwich

into triangles and serve hot.

If you do not have a panini press or grill, cook the sandwich in a heavy nonstick

skillet or on a griddle over medium heat, placing a flat heavy lid on the sandwich

as you brown each side.

MAKES 1 SERVING

Per serving (using rye bread): 311 calories, 13 g protein, 49 g carbohydrates,

4.9 g sugar, 3 g total fat, 8% calories from fat, 0 mg cholesterol, 13.3 g fiber, 849

mg sodium

Sloppy Joes for Two

Here’s a tasty and healthful version of an old favorite.

½ small onion, finely chopped

½ small green bell pepper, cored, seeded, and chopped

½ small red bell pepper, cored, seeded, and chopped

6 medium mushrooms, chopped

¾ cup low-fat vegetarian hamburger crumbles

½ cup fat-free barbecue sauce, such as Bull’s-Eye Original

1 tablespoon tomato paste dissolved in ½ cup hot water

2 sprouted-wheat hamburger buns, such as Alvarado Street Bakery buns, split

and toasted

Steam-fry the onions, peppers, and mushrooms in a heavy nonstick skillet over

high heat until softened, adding water by the tablespoon as needed to prevent

sticking and burning.

Add the hamburger crumbles, barbecue sauce, and tomato paste mixture. Cook,

stirring, until the sauce is the desired consistency. Spoon over the split buns or

fill them like a sandwich.

MAKES 2 SERVINGS

Per serving: 218 calories, 14 g protein, 40 g carbohydrates, 11 g sugar, 2 g total

fat, 7% calories from fat, 0 mg cholesterol, 6 g fiber, 508 mg sodium

Orange Quinoa and Bulgur Tabbouleh

This is a delicious and unusual version of the well-known Middle eastern salad.

½ cup medium-grain bulgur wheat

1½ cups water

½ cup quinoa

¾ cup Fat-Free Oil Substitute

¼ cup lemon juice

1 teaspoon salt

1 teaspoon ground coriander

2 pinches ground cinnamon

Freshly ground black pepper to taste

2 cups chopped fresh parsley

1 cup cooked or canned black-eyed peas, rinsed and drained

⅔ cup chopped, seeded green bell pepper

½ cup chopped fresh mint or lemon balm

½ cup chopped scallion

Grated peel of 2 oranges

4 jarred roasted red peppers, rinsed and chopped

Orange wedges (optional)

Mint, parsley, or lemon balm sprigs (optional)

Soak the bulgur in ½ cup boiling water in a large bowl, covered, for 30 minutes.

Meanwhile, bring the quinoa and 1 cup water to a boil in a small saucepan.

Reduce the heat to low, cover, and cook for 15 minutes. Remove from the heat

and let stand until the bulgur is ready.

Whisk or blend together the oil substitute, lemon juice, salt, coriander,

cinnamon, and black pepper in a small bowl. Set aside.

Combine the quinoa with the bulgur. Add the parsley, black-eyed peas, bell

pepper, mint or lemon balm, scallion, orange peel, red peppers, and oil dressing

and mix well. Garnish with orange wedges and sprigs of mint, parsley, or lemon

balm, if desired. Refrigerate, but let stand at room temperature for 30 minutes

before serving.

MAKES 8 SERVINGS

Per serving: 136 calories, 5 g protein, 29 g carbohydrates, 2 g sugar, 1 g total

fat, 7% calories from fat, 0 mg cholesterol, 7 g fiber, 303 mg sodium

Cherry Tomato and Brown Rice Salad with Artichoke Hearts

This delicious salad is a complete meal and a great picnic or potluck dish.

Because neither tomatoes nor rice benefit from refrigeration, it should be served

at room temperature.

3 cups cooked brown basmati rice, warm

6 ounces marinated artichoke hearts, rinsed in hot water, drained, and sliced

1 cup chopped scallions

1½ pounds red, yellow, or mixed cherry tomatoes, halved

½ cup chopped fresh basil

½ cup fat-free Italian dressing

3 tablespoons lemon juice

2 cloves garlic, crushed

¼ teaspoon salt

Freshly ground black pepper to taste

1 head crisp lettuce

Place the rice in a large salad bowl and add the artichokes, scallions, tomatoes,

and basil. Mix gently.

Combine the italian dressing, lemon juice, garlic, salt, and pepper in a small

bowl or jar. Whisk or shake until well blended. Pour over the salad and mix

gently. Serve on beds of lettuce on individual plates.

MAKES 6 SERVINGS

Per serving: 153 calories, 4 g protein, 32 g carbohydrates, 3 g sugar, 1 g total

fat, 6% calories from fat, 0 mg cholesterol, 4 g fiber, 376 mg sodium

Thai-Style Coleslaw

This easy coleslaw makes a great winter accompaniment to an Asian meal or

spices up any other meal.

3 cups finely shredded green or savoy cabbage

1 medium carrot, shredded

1 small sweet onion, thinly sliced

2 tablespoons minced fresh mint or 2 teaspoons dried mint

2 tablespoons minced fresh cilantro, basil, or parsley

2 tablespoons low-sodium soy sauce

2 tablespoons lime juice

2 tablespoons water

1 tablespoon sugar

1 tablespoon grated lime peel

1½ teaspoons toasted sesame seeds

Combine the cabbage, carrot, onion, mint, and cilantro, basil, or parsley in a

serving bowl.

Combine the soy sauce, lime juice, water, sugar, and lime peel in a small bowl.

Pour over the salad, mix well, and refrigerate until ready to serve. Sprinkle with

the sesame seeds before serving.

MAKES 4 SERVINGS

Per serving: 61 calories, 2 g protein, 13 g carbohydrates, 8 g sugar, 1 g total fat,

10% calories from fat, 0 mg cholesterol, 3 g fiber, 334 mg sodium

Red Cabbage Slaw with Cranberries and Apples

This is a very easy, attractive, and delicious make-ahead salad for winter holiday

meals. A blender makes the vinaigrette in a jiffy.

Cranberry-orange Vinaigrette

¾ cup Fat-Free Oil Substitute

½ cup orange juice

⅓ cup chopped fresh or frozen cranberries

2 tablespoons red wine vinegar

1½ tablespoons chopped chives or scallion

1 tablespoon balsamic vinegar

1 tablespoon lemon juice

1 tablespoon sugar

1 large clove garlic, crushed

1 teaspoon salt

Freshly ground black pepper to taste

Salad

1½ pounds red cabbage, thinly sliced (about 5 cups)

¾ cup fresh or frozen cranberries

2 crisp sweet apples, sliced

For the vinaigrette: Blend the oil substitute, orange juice, cranberries, wine

vinegar, chives or scallion, balsamic vinegar, lemon juice, sugar, garlic, salt, and

pepper in a blender. If making ahead, transfer to a covered container and

refrigerate.

For the salad: Combine the cabbage, cranberries, and vinaigrette in a medium

salad bowl and toss gently. Cover and refrigerate for at least 2 hours to allow the

flavors to blend. When ready to serve, slice the apples (with peel), add to the

salad, and toss well.

MAKES 8 SERVINGS

Per serving: 70 calories, 1 g protein, 18 g carbohydrates, 11 g sugar, 0.5 g total

fat, 2% calories from fat, 0 mg cholesterol, 3 g fiber, 251 mg sodium

Sautéed Portobello Mushroom Salad

This is a very simple and delicious salad for two.

8 cups cleaned mixed baby salad greens

¼ cup Fat-Free Oil Substitute

2 tablespoons balsamic vinegar

1 teaspoon Dijon mustard

¼ teaspoon salt

¼ teaspoon coarsely ground black pepper

2 large portobello mushrooms

Wine or vegetable broth

4 scallions, sliced

Divide the greens between two serving plates. In a small bowl, whisk together

the oil substitute, vinegar, mustard, salt, and pepper. Set aside.

Remove the stems from the mushrooms and scrape away the dark gills with the

edge of a spoon.

Heat a large, heavy nonstick skillet over high heat and add the mushrooms.

Cover and cook until slightly browned on the bottoms and beginning to release a

bit of liquid. Add a very small amount of wine or broth as needed to prevent

sticking. Turn the mushrooms and brown the other side.

Quickly slice the mushrooms and place them evenly over the greens. Drizzle

with the dressing, sprinkle with the scallions, and serve immediately.

MAKES 2 SERVINGS

Per serving: 95 calories, 7 g protein, 19 g carbohydrates, 4 g sugar, 1 g total fat,

6% calories from fat, 0 mg cholesterol, 7 g fiber, 308 mg sodium

BLT Salad

A salad version of the well-loved sandwich that uses a handy mayonnaise

substitute. Cooks, plug in your blenders!

Tofu mayonnaise

1 package (12.3 ounces) reduced-fat extra-firm silken tofu

2 tablespoons cider vinegar or lemon juice

1⅛ teaspoons salt

½ teaspoon dry mustard

⅛ teaspoon white pepper

Salad

6 cups torn romaine lettuce

6 cups cubed sprouted-wheat bread, lightly toasted

4 slices low-fat vegetarian bacon, such as Yves Veggie Canadian Bacon or

Lightlife Fakin’ Bacon

2 cups chopped ripe firm tomatoes

2 scallions, sliced

½ cup cider vinegar

⅓ cup Fat-Free Oil Substitute

¼ cup Tofu Mayonnaise

5 teaspoons sugar

Freshly ground black pepper to taste

For the mayonnaise: Combine the tofu, vinegar or lemon juice, salt, mustard,

and pepper in a food processor or blender (or place the ingredients in a medium

bowl and use a hand-held blender) and process until very smooth. It will keep in

a covered container in the refrigerator for about 2 weeks.

For the salad: Combine the lettuce, bread cubes, bacon, tomatoes, and scallions

in a large bowl.

Whisk together the vinegar, oil substitute, tofu mayonnaise, sugar, and pepper in

a medium bowl until well blended. Toss with the salad. Divide the salad evenly

among 4 salad bowls or plates and serve immediately.

MAKES 4 SERVINGS

Per serving: 259 calories, 13 g protein, 42 g carbohydrates, 11 g sugar, 2 g total

fat, 8% calories from fat, 0 mg cholesterol, 10 g fiber, 639 mg sodium

Main Courses

Balkan-Style Slow-Cooker Stew

Balkan cooking is similar to Greek cuisine. Serve with toasted sprouted-wheat

bread or buns for dipping.

3 large onions, sliced

3 cloves garlic, minced

4 large red, yellow, green, or mixed bell peppers, sliced into thin strips

12 ounces low-fat chicken substitute strips, such as Yves Veggie Chicken

Tenders or Lightlife Smart Menu Chik’n Strips

1 can (14 ounces) low-sodium diced tomatoes

1 small dried red chile pepper, seeded

½ teaspoon ground cloves

½ teaspoon ground cinnamon

¼ teaspoon ground allspice

2 cups low-sodium vegetarian broth

Salt to taste

Freshly ground black pepper to taste

Heat a large, heavy nonstick skillet over high heat. Add the onions, garlic, and

bell peppers. Steam-fry until the onion softens, adding very small amounts of

water as needed to prevent sticking and burning.

Place the chicken substitute strips in a slow cooker and spoon the cooked

vegetables on top. Stir in the tomatoes (with juice), chile pepper, cloves,

cinnamon, allspice, and broth. Cook on high for 3 hours. Season with the salt

and black pepper.

MAKES 4 SERVINGS

Per serving: 185 calories, 19 g protein, 30 g carbohydrates, 12 g sugar, 1 g total

fat, 2% calories from fat, 0 mg cholesterol, 9 g fiber, 550 mg sodium

White Bean and Sweet Potato Stew

All you need is whole grain bread to go with this Italian-inspired stew.

1 large onion, chopped

4 cloves garlic, chopped

3 cups cooked or 2 cans (15 ounces each) cannellini, white kidney, or great

Northern beans, rinsed and drained

1 can (28 ounces) low-sodium diced tomatoes

1 pound sweet potatoes, peeled and chopped

12 ounces kale, stripped from stalks, washed, thinly sliced, and briefly

steamed

8 ounces cremini mushrooms, sliced

½ cup low-sodium vegetarian broth

½ cup dry red wine (can be nonalcoholic) or ¼ cup dry sherry

1 tablespoon vegetarian bacon bits

1 teaspoon salt

1 teaspoon dried rosemary

1 teaspoon dried thyme

1 teaspoon dried basil

1 bay leaf

¼ teaspoon crushed red pepper

Salt to taste

Freshly ground black pepper to taste

Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium

heat until soft, adding very small amounts of water, wine, or broth as needed to

prevent sticking and burning. (Or place in a microwaveable dish, cover, and

microwave on high power for 5 minutes.)

Combine the onions and garlic with the beans, tomatoes (with juice), sweet

potatoes, kale, mushrooms, broth, wine, bacon bits, salt, rosemary, thyme, basil,

bay leaf, and red pepper in a slow cooker. Cook on low for 6 to 7 hours or on

high for 3 to 4 hours. Remove the bay leaf and season with the salt and pepper.

MAKES 6 SERVINGS

Per serving: 257 calories, 14 g protein, 50 g carbohydrates, 9 g sugar, 2 g total

fat, 4% calories from fat, 0 mg cholesterol, 12 g fiber, 418 mg sodium

Lebanese-Style Lentils and Pasta

This delicious Lebanese dish makes a full meal.

5 cups low-sodium vegetarian broth

1 cup uncooked brown lentils, rinsed

2 medium onions, chopped

2 cloves garlic, chopped

1 teaspoon ground cumin

4 cups chopped chard, kale, or other greens or 1 package (10 ounces) frozen

chopped spinach, thawed and squeezed dry

4 ounces spaghetti or spaghettini (preferably whole wheat), broken into 4"-

long pieces

¼ cup chopped fresh parsley or cilantro (optional) pinch of cayenne pepper

2 tablespoons lemon juice

Salt to taste

Freshly ground black pepper to taste

Bring the broth and lentils to a boil in a medium saucepan. Reduce the heat to

low, cover, and cook for about 25 minutes or until the lentils are tender but still

hold their shape.

Steam-fry the onions, garlic, and cumin in a large, heavy nonstick saucepan, stir-

fry pan, or deep skillet until soft, adding very small amounts of water as needed

to prevent sticking and burning. (Or place in a microwaveable dish, cover, and

microwave on high for 7 minutes.)

Pour the lentils and broth into the pan with the onions. Add the greens, pasta,

parsley or cilantro, if desired, and cayenne. Bring to a boil, then reduce the heat

to medium. Cook, uncovered, for about 10 minutes or until the pasta is tender

and most of the broth has been absorbed, leaving a sauce. Add the lemon juice

and mix well. Season with the salt and black pepper. Serve hot.

MAKES 4 SERVINGS

Per serving: 318 calories, 20 g protein, 61 g carbohydrates, 7 g sugar, 1 g total

fat, 3% calories from fat, 0 mg cholesterol, 17 g fiber, 204 mg sodium

Lemon and Artichoke Tagine (Moroccan Stew)

Serve this delicious stew with Bulgur Wheat and Quinoa Pilaf.

2 tablespoons whole wheat flour

12 ounces low-fat chicken substitute strips, such as Yves Veggie Chicken

Tenders, Lightlife Smart Menu Chik’n Strips, or Morningstar Farms Meal

Starters Chik’n Strips

1 large onion, sliced

6 cloves garlic, chopped

2 cups sliced mushrooms

1 large green or red bell pepper, cored, seeded, and cut into chunks

2 cups low-sodium vegetarian broth

1 tablespoon ground coriander

1 tablespoon dried parsley

½ teaspoon black pepper

¼ teaspoon ground turmeric

¼ teaspoon ground ginger

¼ teaspoon paprika

¼ teaspoon crushed red pepper

1 lemon, with peel, sliced and seeded

1 jar (7 ounces) marinated artichoke heart quarters, rinsed under hot water and

drained

Salt to taste

Place the flour in a shallow dish and roll the chicken substitute strips to coat.

Place the strips in a large, heavy, deep nonstick skillet or stir-fry pan over

medium-high heat and cook until browned. Remove from the pan and set aside.

Add the onion and garlic to the skillet and steam-fry until soft, adding very small

amounts of water as needed to prevent sticking and burning. (Or place in a

microwaveable dish, cover, and microwave on high for 7 minutes.)

Add the strips, mushrooms, bell pepper, broth, coriander, parsley, black pepper,

turmeric, ginger, paprika, and red pepper. Place the lemon slices on top of the

stew, cover, reduce the heat, and simmer for 30 minutes.

Remove and discard the lemon slices. Stir in the artichokes and cook just until

heated. Season with the salt and serve immediately.

MAKES 4 SERVINGS

Per serving: 165 calories, 20 g protein, 25 g carbohydrates, 3 g sugar, 1 g total

fat, 3% calories from fat, 0 mg cholesterol, 10 g fiber, 584 mg sodium

Pasta with Lentil Marinara Sauce

Red wine (which can be a nonalcoholic variety) lends a rich flavor to this sauce,

which is ready in the time it takes to cook the pasta.

1 pound pasta of choice

1 jar (26 ounces) fat-free low-sodium tomato-based pasta sauce

1 can (15 ounces) lentils, rinsed and drained

½ cup dry red wine (can be nonalcoholic) or low-sodium vegetarian broth

Salt to taste

Freshly ground black pepper

Cook the pasta according to package directions, then drain.

Meanwhile, combine the pasta sauce, lentils, and wine or broth in a medium

saucepan. Heat gently and season with the salt and pepper. Serve over the pasta.

MAKES 5 SERVINGS

Per serving: 470 calories, 19 g protein, 91 g carbohydrates, 9 g sugar, 2 g total

fat, 3% calories from fat, 0 mg cholesterol, 8 g fiber, 173 mg sodium

Vegetarian Mixed-Bean Chili Express

This chili is an absolutely delicious savory treat. Serve it with brown basmati

rice, sprouted-grain bread or buns, corn or sprouted-wheat tortillas, soft fresh

polenta or cornbread, and a salad. Leftovers freeze well.

6 cloves garlic, minced or crushed

1 tablespoon chili powder (preferably a dark variety, such as ancho)

1 tablespoon dried oregano

1½ teaspoons ground cumin

½ teaspoon crushed red pepper

1 can (28 ounces) low-sodium diced tomatoes

1½ cups cooked or 1 can (15 ounces) pinto beans, rinsed and drained

1½ cups cooked or 1 can (15 ounces) black beans, rinsed and drained

1½ cups cooked or 1 can (15 ounces) small red or red kidney beans, rinsed

and drained

3 cups hot water

1½ cups dry textured vegetable protein

1 cup frozen whole-kernel corn

1 large green bell pepper, cored, seeded, and chopped

¼ cup low-sodium soy sauce

1 tablespoon hot-pepper sauce

1 tablespoon onion powder

1 tablespoon unsweetened cocoa powder

1 teaspoon sugar

2 tablespoons cornmeal or masa harina

Salt to taste

Steam-fry the garlic in a large, heavy nonstick skillet for 2 minutes. Add the chili

powder, oregano, cumin, and red pepper and stir-fry for 1 minute. Add the

tomatoes (with juice), beans, hot water, vegetable protein, corn, bell pepper, soy

sauce, hot-pepper sauce, onion powder, cocoa, and sugar. Bring to a boil, then

reduce the heat, cover, and simmer for 15 to 30 minutes. During the last 5

minutes of cooking, sprinkle the cornmeal or masa harina over the top and stir in

thoroughly. Season with the salt.

MAKES 6 SERVINGS

Per serving: 329 calories, 26 g protein, 57 g carbohydrates, 7 g sugar, 2 g total

fat, 4% calories from fat, 0 mg cholesterol, 16 g fiber, 457 mg sodium

Black-Eyed Peas with Sweet Potatoes and Greens

A wonderful combination of flavors! Serve with brown rice or fat-free

cornbread, with hot sauce on the side.

1 package (10 ounces) frozen kale, chard, or collard greens

4 cups low-sodium vegetarian broth

2 packages (10 ounces each) frozen black-eyed peas, thawed and drained

2 cloves garlic, minced

1 can (18 ounces) vacuum-packed unsweetened sweet potatoes, drained,

rinsed, and chopped, or 2 cups cooked

A few dashes of liquid smoke

Thaw the greens in the microwave or a bowl of boiling water and drain. Chop

and combine with the broth, black-eyed peas, garlic, sweet potatoes, and liquid

smoke in a large saucepan. Bring to a boil, stirring often, then reduce the heat

and simmer for 20 to 30 minutes.

MAKES 4 SERVINGS

Per serving: 412 calories, 32 g protein, 74 g carbohydrates, 1 g sugar, 4 g total

fat, 8% calories from fat, 0 mg cholesterol, 22 g fiber, 127 mg sodium

Indonesian-Style Stir-Fried Pasta (Bamie)

This dish has just the right exotic touch.

1 pound soy vermicelli pasta

1 medium onion, chopped

6 cloves garlic, minced

½–1 teaspoon crushed red pepper

2 cups shredded napa or savoy cabbage

2 stalks celery, sliced thinly on the diagonal

¼ cup water

6 ounces low-fat beef substitute strips, such as Yves Veggie Beef Tenders,

Lightlife Smart Menu Steak-Style Strips, or Morningstar Farms Meal

Starters Steak Strips

½ cup low-sodium vegetarian broth

¼ cup low-sodium soy sauce

¾ tablespoon maple syrup

¾ tablespoon dark molasses

2 teaspoons cornstarch

1 tablespoon cold water

4 scallions, sliced thinly on the diagonal

Cook the pasta in a large pot of boiling water until tender. Drain in a colander.

In a large, heavy nonstick wok or a skillet lightly coated with oil or cooking

spray, steam-fry the onion, garlic, and red pepper for 1 minute, adding very small

amounts of water as needed to prevent sticking and burning.

Add the cabbage, celery, and ¼ cup water. Cover and cook over high heat for

about 3 minutes. Add the beef substitute strips and stir-fry for about 1 minute.

Combine the broth, soy sauce, maple syrup, molasses, cornstarch, and cold water

in a small bowl. Stir into the pan and cook, stirring, over high heat until it

thickens and boils.

Add the drained pasta and toss well with the sauce. Top with the scallions and

serve.

MAKES 6 SERVINGS

Per serving: 338 calories, 10 g protein, 74 g carbohydrates, 19 g sugar, 1 g total

fat, 2% calories from fat, 0 mg cholesterol, 5 g fiber, 505 mg sodium

Quick Spinach Lasagna

Although it takes a little more than an hour to make this dish, most of that is

cooking time; prep takes just a few minutes.

1 package (10 ounces) frozen spinach, thawed

1 pound reduced-fat firm tofu

1 tablespoon chopped or minced garlic

1 teaspoon salt

1 jar (26 ounces) fat-free low-sodium tomato-based pasta sauce

1 pound whole wheat lasagna noodles

10 button mushrooms, sliced, or 1 cup other vegetable of choice

¼ cup vegan parmesan or nutritional yeast flakes

Preheat the oven to 325°F.

Combine the spinach, tofu, garlic, and salt in a medium bowl.

Coat the bottom of a 9" × 13" baking pan with tomato sauce, then add a layer of

lasagna noodles, overlapping them slightly. Spread half of the spinach mixture

over the noodles. Follow with another layer of noodles, then tomato sauce, and a

layer of mushrooms or other veggies. Repeat until the layers reach the top of the

pan. The final layer should be sauce topped with vegan parmesan or yeast flakes.

Cover tightly with foil and bake for 1 hour. Stick a knife through the center of

the lasagna to be sure the noodles are completely cooked. Let stand for 15

minutes, uncovered, before serving.

MAKES 8 SERVINGS

Per serving: 332 calories, 18 g protein, 5 g carbohydrates, 7 g sugar, 5 g total

fat, 9% calories from fat, 0 mg cholesterol, 9 g fiber, 284 mg sodium

Recipe by Jennifer Reilly, RD

Eggplant Parmesan

This interpretation of an old favorite appeals to modern tastes, with “béchamel”

sauce and vegan Parmesan providing a creamy contrast.

Creamy Béchamel Sauce

½ medium onion, cut into chunks

1 cup water

¾ cup cooked or canned white beans, rinsed and drained

6 ounces reduced-fat firm silken tofu

1 tablespoon nutritional yeast flakes

1 teaspoon salt

¼ teaspoon dried garlic granules

Eggplant

3 pounds eggplant, cut into ¼"-thick slices

¾ cup fine dry bread crumbs

3 cups fat-free tomato-based pasta sauce

2 cups Creamy Béchamel Sauce

½ cup vegan parmesan

For the sauce: Simmer the onion with 1 cup water in a medium saucepan,

covered, for about 10 minutes. Place in a blender or food processor with the

remaining ingredients and blend until very smooth. The sauce can be refrigerated

in a covered container for up to 1 week.

For the eggplant: Arrange the eggplant slices in a single layer on a nonstick

baking sheet. Broil 3" to 4" from the heat on both sides until lightly browned and

soft inside (or grill on a nonstick indoor grill).

Preheat the oven to 325°F. Lay half of the eggplant in the bottom of a 10" round

nonstick baking pan (or a baking pan lined with parchment) and top with half of

the bread crumbs. Spread with half of the pasta sauce, béchamel sauce, and

vegan Parmesan. Repeat with the remaining ingredients. Bake for 20 minutes, or

until bubbly and browned on top.

MAKES 6 SERVINGS

Per serving: 262 calories, 11 g protein, 34 g carbohydrates, 7 g sugar, 1 g total

fat, 6% calories from fat, 0 mg cholesterol, 10 g fiber, 697 mg sodium

Easy Veggie Fajitas

This restaurant favorite is easy to make at home.

1 medium onion, cut into strips

¼ cup low-sodium vegetarian broth or water

1 teaspoon ground cumin

3 red, yellow, green, or mixed bell peppers, cored, seeded, and cut into strips

2 cans (15 ounces each) black beans, drained and rinsed

6 whole wheat tortillas (8" to 10")

1 cup no-sugar-added tomato salsa

Steam-fry the onion in a large, heavy nonstick skillet until soft, adding very

small amounts of broth or water as needed to prevent sticking and burning. Add

the cumin and bell peppers and cook over medium heat until the peppers are

tender. Heat the beans on high in the microwave for 1 minute.

Place a tortilla in a large, heavy skillet over medium-low heat. Add ½ cup of the

beans and ½ cup of the onion mixture. Fold the tortilla in half over the filling

and cook for 3 minutes. Repeat with the remaining tortillas and filling. Top with

salsa and serve.

MAKES 6 SERVINGS

Per serving: 257 calories, 13 g protein, 50 g carbohydrates, 8 g sugar, 2 g total

fat, 7% calories from fat, 0 mg cholesterol, 11 g fiber, 408 mg sodium

Recipe by Jennifer Reilly, RD

Sides

Orange Couscous Pilaf

Couscous looks like a grain but is actually a type of semolina pasta that cooks

quickly and makes a delicious side dish.

2 cups low-sodium vegetarian broth

1 cup couscous

1 cup grated carrots

2 large oranges, peeled and cut into small chunks

4 teaspoons grated orange peel

2 tablespoons raisins

¼ teaspoon salt

¼ teaspoon ground cinnamon

Bring the broth and couscous to a boil in a large saucepan over high heat. Add

the carrots, oranges, orange peel, raisins, salt, and cinnamon. Return to a boil,

then turn off the heat, cover, and let stand for 10 minutes or until all liquid is

absorbed. Fluff with a fork.

MAKES 4 SERVINGS

Per serving: 238 calories, 7 g protein, 52 g carbohydrates, 4 g sugar, 1 g total

fat, 2% calories from fat, 0 mg cholesterol, 7 g fiber, 143 mg sodium

Brussels Sprouts with Lemon and Vegetarian Bacon

This is a delicious and quick brussels sprout dish. You can partially cook the

sprouts ahead of time, stop the cooking with ice water, and then assemble and

stir-fry the dish in minutes just before serving.

3 pounds brussels sprouts, trimmed and halved vertically

1 cup chopped vegetarian bacon (about 8 slices), such as Yves Veggie

Canadian Bacon or Lightlife Fakin’ Bacon

4 scallions, chopped

¼ cup low-sodium vegetarian broth salt to taste

Freshly ground black pepper to taste

2 tablespoons lemon juice

Add the brussels sprouts to a saucepan of boiling water and cook for 3 minutes.

Drain immediately and plunge into ice-cold water to stop the cooking process.

When they are cold, drain well.

Heat a large nonstick skillet, wok, or stir-fry pan over high heat. Add the bacon

and scallions and steam-fry until the scallions are soft, adding very small

amounts of water as needed to prevent sticking and burning. Add the sprouts and

broth and stir-fry for about 3 minutes. Season with the salt and pepper and

drizzle with the lemon juice. Toss and serve immediately.

MAKES 8 SERVINGS

Per serving: 71 calories, 12 g protein, 5 g carbohydrates, 1 g sugar, 0.5 g total

fat, 6% calories from fat, 0 mg cholesterol, 2 g fiber, 331 mg sodium

Bulgur Wheat and Quinoa Pilaf

This is a tasty side dish for any meal.

1 cup bulgur wheat

1 cup quinoa

1 large onion, chopped

1 cup chopped celery

4 cups low-sodium vegetarian broth

¼ cup minced fresh parsley

1 teaspoon crushed dried rosemary or dried thyme or oregano

Salt to taste

Place the bulgur and quinoa in a dry heavy skillet (such as cast-iron), stir-fry

pan, or wok over high heat and cook, stirring constantly, until the grain smells

toasty. Remove from the heat immediately and set aside.

Steam-fry the onion and celery in a large nonstick saucepan with a tight lid until

the onion begins to soften. Add the broth, bulgur, quinoa, parsley, and rosemary,

thyme, or oregano. Bring to a boil over high heat, then reduce the heat to low

and cook, covered, for 20 minutes. Let stand for 5 minutes. Fluff with a fork and

season with the salt.

MAKES 8 SERVINGS

Per serving: 174 calories, 6 g protein, 36 g carbohydrates, 1 g sugar, 2 g total

fat, 7% calories from fat, 0 mg cholesterol, 6 g fiber, 46 mg sodium

Broccoli Stir-Fry in Black Bean Sauce

This is a colorful, quick, and fiber-rich accompaniment to any Asian-style meal.

1 teaspoon minced or grated fresh ginger

2 teaspoons crushed garlic

2 tablespoons Chinese black bean sauce

1 bunch broccoli

1 large onion, cut into 6 wedges and layers separated

2 tablespoons water

3 tablespoons dry sherry or nonalcoholic sweet wine, such as Riesling

1½ teaspoons cornstarch dissolved in ½ cup cold water

Mash the ginger and garlic together in a small bowl. Add the black bean sauce

and mix well.

Divide the broccoli florets into bite-size pieces. Peel and chop the stems into ½"

pieces and stir-fry with the florets and onion in a medium skillet over high heat.

Add 2 tablespoons water, cover, and cook for 4 to 5 minutes or just until the

broccoli is crisp-tender (add a little more water if necessary).

Add the ginger mixture, sherry or wine, and cornstarch mixture and stir until the

sauce is thickened. Serve immediately.

MAKES 4 SERVINGS

Per serving: 85 calories, 6 g protein, 15 g carbohydrates, 1 g sugar, 1 g total fat,

4% calories from fat, 0 mg cholesterol, 0.5 g fiber, 416 mg sodium

Roasted Sweet Potatoes with Moroccan Spices

These sweet potatoes are easy to prepare, but your guests don’t have to know

that. The seeds add crunch as well as spice.

1½ pounds orange-fleshed sweet potatoes, peeled, halved lengthwise, and cut

crosswise into ½" slices

¼ cup fat-free Italian dressing

1 tablespoon maple syrup

1½ teaspoons grated lemon peel

1½ teaspoons coriander seeds

1½ teaspoons cumin seeds

1½ teaspoons mustard seeds

Salt to taste

Freshly ground black pepper to taste

Position a rack in the bottom third of the oven and preheat the oven to 375°F.

Toss the sweet potatoes, dressing, maple syrup, lemon peel, and coriander,

cumin, and mustard seeds together in a heavy nonstick rimmed baking sheet or

shallow baking pan, then spread evenly in a shallow layer. Sprinkle with salt and

pepper. Roast until tender and golden brown, stirring occasionally, for 30 to 45

minutes. Serve hot.

MAKES 5 SERVINGS

Per serving: 145 calories, 3 g protein, 33 g carbohydrates, 9 g sugar, 1 g total

fat, 3% calories from fat, 0 mg cholesterol, 5 g fiber, 233 mg sodium

Roasted Green Beans, Fennel, Red Pepper, and Cauliflower with

Dill

This is a delicious, easy, and colorful vegetable presentation.

2 medium fennel bulbs, tops cut off, halved, trimmed, and sliced

1 medium cauliflower, trimmed, broken into florets, and sliced

2 large red bell peppers, cored, seeded, and thickly sliced

6 cups fresh green beans, trimmed, or frozen whole young green beans

½ cup fat-free Italian dressing

2 tablespoons lemon juice

2 teaspoons dried dill weed or 2 tablespoons chopped fresh dill

1 teaspoon dried garlic granules

¼ cup chopped fennel leaves

Salt to taste

Freshly ground black pepper to taste

Preheat the oven to 350°F. Combine the fennel bulbs, cauliflower, bell peppers,

beans, dressing, lemon juice, dill, garlic granules, fennel leaves, salt, and black

pepper in a single layer in a large, shallow nonstick baking pan (use two pans if

necessary to keep the vegetables in 1 shallow layer).

Place the pan or pans on the bottom oven rack. Bake for about 40 minutes,

stirring occasionally with a spatula, until the vegetables are tender and beginning

to brown slightly. Serve hot.

MAKES 8 SERVINGS

Per serving: 85 calories, 4 g protein, 19 g carbohydrates, 6 g sugar, 0.5 g total

fat, 3% calories from fat, 0 mg cholesterol, 7 g fiber, 254 mg sodium

Desserts

Chocolate-Dipped Strawberries

This treat gives you the taste of rich chocolate with the healthful goodness of

fresh fruit. Wax Orchards fat-free, fruit-sweetened organic fudge toppings are

available in most health food stores. They come in six varieties.

¼ cup Wax Orchards fudge topping

12 large fresh whole strawberries, cleaned, with stems

Heat the topping in a small saucepan just until softened. Divide equally into 2

small bowls. Hold the strawberries by the stem ends, dip in the topping, and

enjoy!

MAKES 2 SERVINGS

Per serving: 125 calories, 1 g protein, 29 g carbohydrates, 23 g sugar, 1 g total

fat, 5% calories from fat, 0 mg cholesterol, 4 g fiber, 41 mg sodium

Cranberry–Orange–Pear Granola Crisp

Cranberries, oranges, and pears are made for each other. Serve this crisp with

Lemon Crème.

4 large firm ripe pears, peeled, cored, and thinly sliced

2½ cups cranberries, thawed if frozen

Juice and finely grated peel of 1 medium orange

¼ teaspoon salt

¼ teaspoon freshly grated nutmeg

¼ teaspoon ground ginger

¾ cup (6 ounces) thawed frozen pear or apple juice concentrate or mixed pear,

apple, and peach juice concentrate

2 tablespoons cornstarch

2 cups reduced-fat granola (no more than 4 percent calories from fat), such as

Health Valley

Preheat the oven to 400°F. Combine the pears, cranberries, orange juice, orange

peel, salt, nutmeg, and ginger in a large bowl. Stir the juice concentrate and

cornstarch together in a small bowl. Immediately pour into the fruit mixture and

blend well. Pour into a 2-quart nonstick baking dish (or a baking dish lined with

parchment). Bake for 20 minutes. Remove from the oven and reduce the heat to

350°F. Stir the fruit mixture thoroughly and sprinkle the granola evenly on top.

Bake for 20 to 30 minutes or until the fruit is soft. Serve warm.

MAKES 8 SERVINGS

Per serving: 201 calories, 3 g protein, 51 g carbohydrates, 27 g sugar, 1 g total

fat, 2% calories from fat, 0 mg cholesterol, 7 g fiber, 101 mg sodium

Lemon Crème

This simply delicious crème can be used as a pudding or a topping for fruit or

cake. All you need are three ingredients (you use the lemon peel and the juice)

and your blender.

1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled

⅓ cup Grade A (light) maple syrup or agave nectar

3 tablespoons fresh lemon juice

1 tablespoon grated lemon peel

Blend the tofu, maple syrup or agave nectar, lemon juice, and lemon peel until

very smooth in a blender or food processor (or place in a bowl and use a hand-

held blender). Refrigerate in a covered container until chilled.

MAKES 1¾ CUPS (4 SERVINGS)

Per serving: 106 calories, 6 g protein, 20 g carbohydrates, 17 g sugar, 1 g total

fat, 5% calories from fat, 0 mg cholesterol, 0.5 g fiber, 88 mg sodium

Variation

Lemon-Ginger Crème: Fold in ¼ cup finely minced crystallized ginger.

Pineapple Sherbet Pops

You can make this variation on a favorite summer treat with a blender and just

six ingredients.

1 package (12.3 ounces) reduced-fat firm or extra-firm silken tofu

3 tablespoons agave nectar or ⅓ cup sugar

4 teaspoons lemon juice

¾ teaspoon vanilla extract

1 can (19 ounces) juice-packed unsweetened crushed pineapple

¼ teaspoon coconut extract

Place the tofu, agave nectar or sugar, lemon juice, vanilla, pineapple (with juice),

and coconut extract in a blender and process until smooth. Pour into 18 small ice

pop molds, insert sticks, and freeze until solid. To serve, dip the bottoms of the

molds in hot water for a few seconds so the pops slide out easily.

MAKES 18 SERVINGS

Per popsicle: 30 calories, 2 g protein, 6 g carbohydrates, 6 g sugar, 0.5 g total

fat, 4% calories from fat, 0 mg cholesterol, 0.5 g fiber, 19 mg sodium

Berry Mousse

This is so easy that it’s hardly a recipe! Your blender does most of the work. This

can be eaten as a pudding or used as a topping for fruit.

1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled

2¾ cups thawed frozen unsweetened berries of choice

3 tablespoons sugar or 2 tablespoons agave nectar

1 tablespoon berry liqueur (optional)

Blend the tofu, berries, sugar or agave nectar, and liqueur, if desired, in a blender

or food processor until smooth. Spoon into 4 pudding dishes and refrigerate until

chilled.

MAKES 4 SERVINGS

Per serving: 123 calories, 7 g protein, 24 g carbohydrates, 17 g sugar, 1 g total

fat, 5% calories from fat, 0 mg cholesterol, 3 g fiber, 89 mg sodium

Orange-Applesauce Date Cake

This easy lunchbox cake is moist and delicious—and even better the next day.

The applesauce replaces both eggs and fat.

1 cup unsweetened smooth applesauce

1 tablespoon lemon juice

2 tablespoons water

1 tablespoon grated orange peel

1 cup whole wheat pastry flour (not regular whole wheat flour)

½ cup brown sugar

¼ cup oat flour (oatmeal ground in a dry blender or electric coffee mill) or

barley flour

½ teaspoon ground cinnamon

¼ teaspoon salt

⅛ teaspoon ground nutmeg

⅛ teaspoon ground allspice

1 teaspoon baking soda

1 cup chopped pitted dates

Preheat the oven to 350°F. Place the applesauce, lemon juice, and 2 tablespoons

water in a small saucepan over medium heat and warm slowly. Add the orange

peel.

Mix the pastry flour, brown sugar, oat or barley flour, cinnamon, salt, nutmeg,

and allspice in a medium bowl.

Stir the baking soda into the applesauce mixture (it will foam up). Pour

immediately into the flour mixture and stir briefly but thoroughly.

Add the dates and mix briefly. Scoop the batter into a nonstick 9" × 9" cake pan,

smooth the top, and bake for 10 minutes. Reduce the heat to 325°F and bake for

25 to 30 minutes or until it tests done with a cake tester. Transfer to a rack and

cool completely. Make 2 evenly spaced cuts through the cake vertically, then

horizontally, to make 9 squares.

MAKES 9 SERVINGS

Per serving: 169 calories, 3 g protein, 41 g carbohydrates, 24 g sugar, 0.5 g

total fat, 2% calories from fat, 0 mg cholesterol, 4 g fiber, 199 mg sodium

NOTES
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A.   S.   Nicholson   et   al.,   “Toward   Improved   Management   of   NIDDM:   A
Randomized,   Controlled,   Pilot   Intervention   Using   a   Low-Fat,   Vegetarian
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2
N.   D.   Barnard   et   al.,   “The   Effects   of   a   Low-Fat,   Plant-Based   Dietary
Intervention  on  Body  Weight,  Metabolism,  and  Insulin  Sensitivity,”  American
Journal  of  Medicine  118  (2005):  991–97.
CHAPTER  1
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M.   Knip   et   al.,   “Environmental   Triggers   and   Determinants   of   Type   1
Diabetes,”  Diabetes  54,  suppl  2  (December  2005):  S125–36.
CHAPTER  2
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T.   Kuzuya,   “Prevalence   of   Diabetes   Mellitus   in   Japan   Compiled   from
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2
H.   P.   Himsworth,   “The   Dietetic   Factor   Determining   the   Glucose   Tolerance
and  Sensitivity  to  Insulin  of  Healthy  Men,”  Clinical  Science  2  (1935):  67–94.
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D.  B.  Stone  and  W.  E.  Connor,  “The  Prolonged  Effects  of  a  Low-Cholesterol,
High-Carbohydrate   Diet   upon   the   Serum   Lipids   in   Diabetic   Patients,”
Diabetes  12  (1963):  127–32.
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J.   W.   Anderson   and   K.   Ward,   “High-Carbohydrate,   High-Fiber   Diets   for
Insulin-Treated   Men   with   Diabetes   Mellitus,”   American   Journal   of   Clinical
Nutrition  32  (1979):  2312–21.
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R.  J.  Barnard,  T.  Jung,  and  S.  B.  Inkeles,  “Diet  and  Exercise  in  the  Treatment
of  NIDDM:  The  Need  for  Early  Emphasis,”  Diabetes  Care  17  (1994):  1469–
72.
6
A.   S.   Nicholson   et   al.,   “Toward   Improved   Management   of   NIDDM:   A
Randomized,   Controlled,   Pilot   Intervention   Using   a   Low-Fat,   Vegetarian
Diet,”  Preventive  Medicine  29  (1999):  87–91.
7
N.   D.   Barnard   et   al.,   “The   Effects   of   a   Low-Fat,   Plant-Based   Dietary
Intervention  on  Body  Weight,  Metabolism,  and  Insulin  Sensitivity,”  American
Journal  of  Medicine  118  (2005):  991–97.

8
A.  E.  Bunner,  C.  L.  Wells,  J.  Gonzales,  U.  Agarwal,  E.  Bayat,  N.  D.  Barnard.
A   dietary   intervention   for   chronic   diabetic   neuropathy   pain:   a   randomized
controlled   pilot   study.   Nutrition   &   Diabetes   2015   May   26;5:e158.   doi:
10.1038/nutd.2015.8.
9
N.   D.   Barnard   et   al.,   “The   Effects   of   a   Low-Fat,   Plant-Based   Dietary
Intervention  on  Body  Weight,  Metabolism,  and  Insulin  Sensitivity,”  American
Journal  of  Medicine  118  (2005):  991–97.
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I.  M.  Stratton,  A.  L.  Adler,  and  H.  A.  Neil,  “Association  of  Glycaemia  with
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————,   “Intensive   Lifestyle   Changes   for   Reversal   of   Coronary   Heart
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L.   M.   Sparks   et   al.,   “A   High-Fat   Diet   Coordinately   Downregulates   Genes
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CHAPTER  3
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D.   M.   Nathan   et   al.   and   the   Diabetes   Control   and   Complications

Trial/Epidemiology   of   Diabetes   Interventions   and   Complications
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Diabetes   Control   and   Complications   Trial   Research   Group,   “The   Effect   of
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E.  L.  Knight  et  al.,  “The  Impact  of  Protein  Intake  on  Renal  Function  Decline
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J.   Karjalainen   et   al.,   “A   Bovine   Albumin   Peptide   as   a   Possible   Trigger   of
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A.  C.   Alting,  R.   G.  J.   M.  Meijer,   and  E.   C.  H.   van  Beresteijn,   “Incomplete
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7
Ibid.
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American   Academy   of   Pediatrics   Work   Group   on   Cow’s   Milk   Protein   and
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CHAPTER  4

1
L.  M.  Goff  et  al.,  “Veganism  and  Its  Relationship  with  Insulin  Resistance  and
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S.  M.  Kwak,  S.  K.  Myung,  Y.  J.  Lee,  H.  G.  Seo;  Korean  Meta-analysis  study
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and   docosahexaenoic   acid)   in   the   secondary   prevention   of   cardiovascular
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4
S.   Tonstad,   T.   Butler,   R.   Yan,   G.   E.   Fraser.   Type   of   vegetarian   diet,   body
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N.  D.  Barnard,  J.  Cohen,  D.  J.   Jenkins,  G.  Turner-McGrievy,   L.  Gloede,   B.
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glycemic  control  and  cardiovascular  risk  factors  in  a  randomized  clinical  trial
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Y.   Papanikolaou   et   al.,  “Bean   Consumption   by   Adults  Is   Associated   with   a
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V.   L.   Fulgoni   et   al.,   “Bean   Consumption   by   Children   Is   Associated   with
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D.   J.   Jenkins   et   al.,   “Glycemic   Index   of   Foods:   A   Physiological   Basis   for
Carbohydrate  Exchange,”  American  Journal  of  Clinical  Nutrition  34  (1981):
362–6.
22
Ibid.
23
J.   Brand-Miller   et   al.,   “Low-Glycemic   Index   Diets   in   the   Management   of
Diabetes,”  Diabetes  Care  26  (2003):  2261–7.
24
N.   C.   Howarth,   e.   Saltzman,   and   s.   B.   Roberts,   “Dietary   Fiber   and   Weight
regulation,”  Nutrition  Reviews  59  (2001):  129–39.

25
N.   D.   Barnard   et   al.,   “the   Effects   of   a   Low-Fat,   Plant-Based   Dietary
Intervention  on  Body  Weight,  Metabolism,  and  Insulin  Sensitivity,”  American
Journal  of  Medicine  118  (2005):  991–97.
26
M.  G.  Crane  and  c.  Sample,”  “Regression  of  Diabetic  Neuropathy  with  Total
Vegetarian  (Vegan)  Diet,”  Journal  of  Nutritional  Medicine  4  (1994):  431–9.
27
A.  E.  Bunner,  c.  L.  Wells,  J.  Gonzales,  u.  Agarwal,  E.  Bayat,  N.  D.  Barnard.
A   dietary   intervention   for   chronic   diabetic   neuropathy   pain:   a   randomized
controlled   pilot   study.   Nutrition   &   Diabetes   2015   May   26;5:e158.   doi:
10.1038/nutd.2015.8.
28
G.  M.  Turner-McGrievy,  et  al.  Effects  of  a  low-fat,  vegan  diet  and  a  step  II
diet   on   macro-   and   micronutrient   intakes   in   overweight,   postmenopausal
women,  Nutrition  20  (2004):  738–46.
29
E.  L.  Knight  et  al.,  “The  Impact  of  Protein  Intake  on  Renal  Function  Decline
in  Women  with  Normal  Renal  Function  or  Mild  Renal  Insufficiency,”  Annals
of  Internal  Medicine  138  (2003):  460–7.
30
V.   Melina,   W.   Craig,   s.   Levin.   Position   of   the   Academy   of   Nutrition   and
Dietetics:  vegetarian  diets.  Journal  of  the  Academy  of  Nutrition  and  Dietetics
2016;116:1970–80.
31
E.   C.   Westman   et   al.   Effect   of   a   6-month   adherence   to   a   very   low
carbohydrate  diet  program.  American  Journal  of  Medicine  113  (2002):  30–36.
CHAPTER  6
1
N.   D.   Barnard   et   al.,   “The   Effects   of   a   Low-Fat,   Plant-Based   Dietary
Intervention  on  Body  Weight,  Metabolism,  and  Insulin  Sensitivity,”  American
Journal  of  Medicine  118  (2005):  991–97.
2
N.   C.   Howarth,   e.   Saltzman,   and   s.   B.   Roberts,   “Dietary   Fiber   and   Weight
Regulation,”  Nutrition  Reviews  59  (2001):  129–39.
3
Barnard  et  al.,  “The  Effects  of  a  Low-Fat,  Plant-Based  Dietary  Intervention.”
4
J.   A.   Vernarelli,   d.   C.   Mitchell,   B.   J.   Rolls,   t.   J.   Hartman.   Dietary   energy
density  is  associated  with  obesity  and  other  biomarkers  of  chronic  disease  in
us  adults.  European  Journal  Nutrition  2015;54:59–65.
5
A.   M.   Dattilo   and   P.   M.   Kris-Etherton,   “Effects   of   Weight   Reduction   on
Blood   Lipids   and   Lipoproteins:   A   Meta-Analysis,”   American   Journal   of
Clinical  Nutrition  56  (1992):  320–8.
6
E.   C.   Westman   et   al.,   “Effect   of   a   6-Month   Adherence   to   a   Very   Low

Carbohydrate  Diet  Program,”  American  Journal  of  Medicine  113  (2002):  30–
6.
7
W.  S.  Yancy  et  al.,  “A  Low-Carbohydrate,  Ketogenic  Diet  versus  a  Low-Fat
Diet  to  Treat  Obesity  and  Hyperlipidemia,”  Annals  of  Internal  Medicine  130
(2004):  769–77.
8
E.  L.  Knight  et  al.,  “The  Impact  of  Protein  Intake  on  Renal  Function  Decline
in   Women   with   Normal   Renal   Function   or   Mild   Renal   Insufficiency,”
American  Journal  of  Medicine  118  (2005):  460–7.
9
J.   Coresh   et   al.,   “Prevalence   of   chronic   Kidney   Disease   and   Decreased
Kidney   Function   in   the   Adult   us   Population:   Third   National   Health   and
Nutrition   Examination   Survey,”   American   Journal   of   Kidney   Diseases   41
(2003):  1–12.
10
K.   D.   Hall,   t.   Bemis,   r.   Brychta,   et   al.   Calorie   for   calorie,   dietary   fat
restriction  results  in  more  body  fat  loss  than  carbohydrate  restriction  in  people
with  obesity.  Cell  Metabolism.  2015;22:427–36.
CHAPTER  7
1
G.   B.   Bolli   and   J.   E.   Gerich,   “The   ‘Dawn   Phenomenon’—A   Common
Occurrence  in  Both  Non-Insulin-Dependent  and  Insulin-Dependent  Diabetes
Mellitus,”  New  England  Journal  of  Medicine  310  (1984):  746–50.
2
E.  Selvin  et  al.,  “Meta-analysis:  A1C  and  Cardiovascular  Disease  in  Diabetes
Mellitus,”  Annals  of  Internal  Medicine  141  (2004):  421–31.
3
National   Cholesterol   Education   Program,   “Third   Report   of   the   National
Cholesterol   Education   Program   (NCEP)   Expert   Panel   on   Detection,
Evaluation,   and   Treatment   of   High   Blood   Cholesterol   in   Adults   (Adult
Treatment  Panel  III)  Final  Report,”  Circulation  106  (2002):  3143–421.
4
S.  M.  Grundy,  et  al.  “Implications  of  Recent  Clinical  Trials  for  the  National
Cholesterol   Education   Program   Adult   Treatment   Panel   III   Guidelines,”
Circulation  110  (2004):  227–39.
5
American  Diabetes  Association,  2017
CHAPTER  9
1
M.   R.   Yeomans   et   al.,   “Effects   of   Nalmefene   on   Feeding   in   Humans,”
Psychopharmacology  100  (1990):  426–32.
2
D.   J.   Jenkins   et   al.,   “Low-Glycemic   Index   Diet   in   Hyperlipidemia:   Use   of
Traditional   Starchy   Foods,”   American   Journal   of   Clinical   Nutrition   46

(1987):  66–71.
CHAPTER  10
1
J.  Hlebowicz,  A.  Hlebowicz,  s.  Lindstedt,  et  al.  Effects  of  1  and  3  g  cinnamon
on  gastric  emptying,  satiety,  and  postprandial  blood  glucose,  insulin,  glucose-
dependent   insulinotropic   polypeptide,   glucagon-like   peptide   1,   and   ghrelin
concentrations   in   healthy   subjects.   American   Journal   of   Clinical   Nutrition
2009;  89:815–21.
2
R.  M.   van  dam,   F.  B.   Hu,  L.  Rosenberg,  s.  Krishnan,   J.  R.   Palmer.  Dietary
calcium  and   magnesium,  major  food   sources,  and   risk  of   type  2   diabetes  in
U.S.  black  women.  Diabetes  Care  2006  Oct;29(10):2238–43.
3
W.   Mertz,   “Chromium   Occurrence   and   Function   in   Biological   systems,”
Physiological  Reviews  49  (1969):  163–239.
4
K.   N.   Jeejeebhoy   et   al.,   “Chromium   Deficiency,   Glucose   Intolerance,   and
Neuropathy  Reversed  by  Chromium  Supplementation  in  a  Patient  Receiving
Long-term   Total   Parenteral   Nutrition,”   American   Journal   of   Clinical
Nutrition  30  (1977):  531–8.
5
G.  W.  Landman,  h.  J.  Bilo,  s.  t.  Houweling,  N.  Kleefstra.  Chromium  does  not
belong   in   the   diabetes   treatment   arsenal:   current   evidence   and   future
perspectives.  World  Journal  of  Diabetes  2014;5:160–64.
6
S.  Jacob  et  al.,  “Oral  Administration  of  RAC-Alpha-Lipoic  Acid  Modulates
Insulin   Sensitivity   in   Patients   with   Type-2   Diabetes   Mellitus:   A   Placebo-
Controlled  Pilot  Trial,”  Free  Radical  Biology  &  Medicine  27  (1999):  309–14.
7
D.  Ziegler,  P.  A.  Low,  W.  J.  Litchy,  et  al.  Efficacy  and  safety  of  antioxidant
treatment   with   α-lipoic   acid   over   4   years   in   diabetic   polyneuropathy:   the
NATHAN  1  trial.  Diabetes  Care  2011;34(9):2054–60.
CHAPTER  11
1
W.   C.  Knowler  et   al.,  “Reduction  in   the  Incidence   of  Type   2  Diabetes   with
Lifestyle  Intervention  or  Metformin,”  New  England  Journal  of  Medicine  346
(2002):  393–403.
2
D.   E.   Thomas,   e.   J.   Elliott,   G.   A.   Naughton.   Exercise   for   type   2   diabetes
mellitus.  Cochrane  Database  System  Review  2006  Jul  19;(3):cd002968.
3
N.  G.  Boulé  et  al.,  “Effects  of  Exercise  on  Glycemic  Control  and  Body  Mass
in  Type  2  Diabetes  Mellitus:  A  Meta-Analysis  of  Controlled  Clinical  Trials,”
Journal  of  the  American  Medical  Association  286  (2001):  1218–27.

4
G.  Hu  et  al.,  “Physical  Activity,  Cardiovascular  Risk  Factors,  and  Mortality
among  Finnish  Adults  with  Diabetes,”  Diabetes  Care  28  (2005):  799–805.
5
————,   “Leisure   Time,   Occupational,   and   Commuting   Physical   Activity
and  the  Risk  of  Stroke,”  Stroke  36  (2005):  1994–9.
6
Diabetes  Research  in  Children  Network  (DirecNet)  study  Group.  The  effects
of  aerobic  exercise  on  glucose  and  counterregulatory  hormone  concentrations
in  children  with  type  1  diabetes.  Diabetes  Care  29  (2006):  20–25.
CHAPTER  12
1
N.   D.   Barnard,   L.   W.   Scherwitz,   and   D.   Ornish.   “Adherence   and
Acceptability   of   a   Low-Fat,   Vegetarian   Diet   among   Patients   with   Cardiac
Disease,”  Journal  of  Cardiopulmonary  Rehabilitation  12  (1992):  423–31.
2
D.  Ornish  et  al.,  “Can  Lifestyle  Changes  Reverse  Coronary  Heart  Disease?”
Lancet  336  (1990):  129–33.
3
————,   “Intensive   Lifestyle   Changes   for   Reversal   of   Coronary   Heart
Disease.”
4
N.   D.   Barnard,   A.   Akhtar,   and   A.   Nicholson,   “Factors   That   Facilitate
Compliance   to   Lower   Fat   Intake,”   Archives   of   Family   Medicine   4   (1995):
153–8.
5
C.  B.  Esselstyn  Jr.,  “Updating  a  12-Year  Experience  with  Arrest  and  Reversal
Therapy   for   Coronary   Heart   Disease   (an   Overdue   Requiem   for   Palliative
Cardiology),”  American  Journal  of  Cardiology  84  (1999):  339–41.
6
D.  J.  Jenkins,  A.  Mirrahimi,  K.  Srichaikul,  et  al.  Soy  protein  reduces  serum
cholesterol  by  both  intrinsic   and  food  displacement  mechanisms.  Journal  of
Nutrition  2010;140(12):2302s–2311s.
7
P.   M.   Kris-Etherton,   F.   B.   Hu,   E.   Ros,   J.   Sabaté.   The   role   of   tree   nuts   and
peanuts   in   the   prevention   of   coronary   heart   disease:   multiple   potential
mechanisms.  Journal  of  Nutrition  2008  Sep;138(9):1746s–1751s.
8
D.  J.  Jenkins  et  al.,  “Direct  Comparison  of  a  Dietary  Portfolio  of  Cholesterol-
Lowering   Foods   with   a   Statin   in   Hypercholesterolemic   Participants,”
American  Journal  of  Clinical  Nutrition  81  (2005):  380–7.
9
A.  Poobalan,  L.   Aucott,  W.  C.   Smith,  A.  Avenell,   r.   Jung,  J.  Broom,  A.  M.
Grant.  Effects  of  weight  loss  in  overweight/obese  individuals  and  long-term
lipid  outcomes—a  systematic  review.  Obesity  Review  2004;5(1):43–50.
10
S.   Berkow   and   N.   D.   Barnard,   “Blood   Pressure   Regulation   and   Vegetarian

Diets,”  Nutrition  Reviews  63  (2005):  1–8.
CHAPTER  13
1
M.   G.   Crane,   “Sample   c.   Regression   of   Diabetic   Neuropathy   with   Total
Vegetarian  (Vegan)  Diet,”  Journal  of  Nutritional  Medicine  4  (1994):  431–9.
2
D.  Ziegler.  Efficacy  and  safety  of  antioxidant  treatment.
3
D.  F.  Horrobin,  “Essential  Fatty  Acids  in  the  Management  of  Impaired  Nerve
Function  in  Diabetes,”  Diabetes  46,  suppl  2  (1997):  S90–93.
4
A.  A.  Sima.  Acetyl-L-carnitine  in  diabetic  polyneuropathy:  experimental  and
clinical  data.  CNS  Drugs  2007;21  suppl  1:13–23;  discussion  45–6.
5
I.   De   Leeuw   et   al.,   “Long   Term   Magnesium   Supplementation   Influences
Favourably   the   Natural   Evolution   of   Neuropathy   in   Mg-Depleted   type   1
Diabetic  Patients  (T1dm),”  Magnesium  Research  17  (2004):  109–14.
6
M.   Lu   et   al.,   “Prospective   Study   of   Dietary   Fat   and   Risk   of   Cataract
Extraction   among   US   Women,”   American   Journal   of   Epidemiology   161
(2005):  948–59.
7
N.   Karas-Kuzelicki,   V.   Pfeifer,   J.   Lukac-Bajalo.   Synergistic   effect   of   high
lactase   activity   genotype   and   galactose-1-phosphate   uridyl   transferase
(GALT)   mutations   on   idiopathic   presenile   cataract   formation.   Clinical
Biochemistry  2008  Jul;41(10-11):869–74.
8
L.  Ma,  X.  M.  Lin.  Effects  of  lutein  and  zeaxanthin  on  aspects  of  eye  health.
Journal  of  the  Science  of  Food  and  Agriculture  2010  Jan  15;90(1):2–12.  doi:
10.1002/jsfa.3785.
9
R.   G.   Cumming,   P.   Mitchell,   and   W.   Smith,   “Diet   and   Cataract:   The   Blue
Mountains  Eye  study,”  Ophthalmology  107  (2000):  450–6.
10
M.  S.  Morris  et  al.,  “Moderate  Alcoholic  Beverage  Intake  and  Early  Nuclear
and  Cortical  Lens  Opacities,”  Ophthalmic  Epidemiology  11  (2004):  53–65.
11
L.   Azadbakht,   s.   Atabak,   A.   Esmaillzadeh.   Soy   protein   intake,   cardiorenal
indices,   and   c-reactive   protein   in   type   2   diabetes   with   nephropathy:   a
longitudinal  randomized  clinical  trial.  Diabetes  Care  2008  Apr;31(4):648–54.
12
Y.  Yokoyama,  K.  Nishimura,  N.  D.  Barnard,  et  al.  Vegetarian  diets  and  blood
pressure:  a  meta-analysis.  JAMA  International  Medicine  2014;174(4):577–87.

ABOUT THE AUTHOR

Neal Barnard, MD, FACC, is the founder and president of the Physicians

Committee for Responsible Medicine. He has authored more than 70 scientific

publications, as well as 19 books, including the bestsellers Power Foods for the

Brain, 21-Day Weight Loss Kickstart, and Dr. Neal Barnard’s Program for

Reversing Diabetes, and the new Dr. Neal Barnard's Cookbook for Reversing

Diabetes. Dr. Barnard is a frequent lecturer appearing throughout the world and

an adjunct professor of medicine at the George Washington University School of

Medicine. He lives in Washington, DC.

This book is intended as a reference volume only, not as a medical manual.

The information given here is designed to help you make informed decisions about your health. It is not

intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that

you have a medical problem, we urge you to seek competent medical help.

Mention of specific companies, organizations, or authorities in this book does not imply endorsement by the

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book.

Internet addresses and telephone numbers given in this book were accurate at the time it went to press.

First published in hardcover by Rodale Inc. in December 2006.

First published in paperback by Rodale Inc. in February 2008.

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